Ciguatera - Revision history

ClaireLewis: /* References */

2019-09-28T17:19:06Z

References

← Older revision		Revision as of 17:19, 28 September 2019
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	[[Category:Environmental]]		[[Category:Environmental]]
			[[Category:Toxicology]]

ClaireLewis at 17:18, 28 September 2019

2019-09-28T17:18:51Z

← Older revision		Revision as of 17:18, 28 September 2019
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	**[[vomiting]], [[diarrhea]], and [[abdominal cramping]]		**[[vomiting]], [[diarrhea]], and [[abdominal cramping]]
	*Neurologic symptoms		*Neurologic symptoms
	**[[Paresthesias]], painful teeth, [[painful urination]], [[blurred vision]], nerve palsies, respiratory paralysis, [[ataxia]], [[vertigo]], and '''hot/cold temperature reversal''' (cold allodynia)		**[[Paresthesias]], painful teeth, [[painful urination]], [[blurred vision]], [[focal neuro deficit\|nerve palsies]], [[respiratory failure\|respiratory paralysis]], [[ataxia]], [[vertigo]], and '''hot/cold temperature reversal''' (cold allodynia)
	*Cardiovascular symptoms		*Cardiovascular symptoms
	**[[Bradycardia]], [[heart block]], [[pulmonary edema]], and [[hypotension]].		**[[Bradycardia]], [[heart block]], [[pulmonary edema]], and [[hypotension]].
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	==Management==		==Management==
	*Symptomatic therapies are the mainstay of treatment		*Symptomatic therapies are the mainstay of treatment
	**Antiemetics and IVF		**[[Antiemetics]] and [[IVF]]
	**Atropine for bradycardia		**[[Atropine]] for bradycardia
	*[[Mannitol]] - Recommended by several experts for neurologic symptoms if given within 24-48 hours of onset <ref>Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479 </ref>. However, no benefit over normal saline in RCT<ref>Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873</ref>		*[[Mannitol]] - Recommended by several experts for neurologic symptoms if given within 24-48 hours of onset <ref>Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479 </ref>. However, no benefit over normal saline in RCT<ref>Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873</ref>
	**Caution: patients may be hypovolemic due to vomiting/diarrhea and should be appropriately volume resuscitated prior to considering mannitol		**Caution: patients may be hypovolemic due to vomiting/diarrhea and should be appropriately volume resuscitated prior to considering mannitol

Wilkis5611 at 13:52, 22 August 2019

2019-08-22T13:52:31Z

← Older revision		Revision as of 13:52, 22 August 2019
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	==Disposition==		==Disposition==
	*Generally may be discharged		*Generally may be discharged
			*Advise caution that patients should avoid consumption of similar fish for six months as it could trigger a recurrence.

	==See Also==		==See Also==

Kxl328: /* Clinical Features */

2018-10-12T03:14:54Z

Clinical Features

← Older revision		Revision as of 03:14, 12 October 2018
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	**[[vomiting]], [[diarrhea]], and [[abdominal cramping]]		**[[vomiting]], [[diarrhea]], and [[abdominal cramping]]
	*Neurologic symptoms		*Neurologic symptoms
	**[[Paresthesias]], painful teeth, [[painful urination]], [[blurred vision]], nerve palsies, respiratory paralysis, [[ataxia]], [[vertigo]], and '''hot/cold temperature reversal'''		**[[Paresthesias]], painful teeth, [[painful urination]], [[blurred vision]], nerve palsies, respiratory paralysis, [[ataxia]], [[vertigo]], and '''hot/cold temperature reversal''' (cold allodynia)
	*Cardiovascular symptoms		*Cardiovascular symptoms
	**[[Bradycardia]], [[heart block]], [[pulmonary edema]], and [[hypotension]].		**[[Bradycardia]], [[heart block]], [[pulmonary edema]], and [[hypotension]].

Rossdonaldson1: /* Clinical Features */

2017-09-14T06:19:23Z

Clinical Features

← Older revision		Revision as of 06:19, 14 September 2017
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	==Clinical Features==		==Clinical Features==
	*GI symptoms (~3-30 hours after consumption)		*GI symptoms (~3-30 hours after consumption)
	**vomiting, diarrhea, and abdominal cramping		**[[vomiting]], [[diarrhea]], and [[abdominal cramping]]
	*Neurologic symptoms		*Neurologic symptoms
	**Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, respiratory paralysis, ataxia, vertigo, and hot/cold temperature reversal		**[[Paresthesias]], painful teeth, [[painful urination]], [[blurred vision]], nerve palsies, respiratory paralysis, [[ataxia]], [[vertigo]], and '''hot/cold temperature reversal'''
	*Cardiovascular symptoms		*Cardiovascular symptoms
	**Bradycardia, heart block, pulmonary edema, and hypotension.		**[[Bradycardia]], [[heart block]], [[pulmonary edema]], and [[hypotension]].

	==Differential Diagnosis==		==Differential Diagnosis==

Adriack: /* Clinical Features */

2017-09-12T16:53:32Z

Clinical Features

← Older revision		Revision as of 16:53, 12 September 2017
Line 11:		Line 11:
	**vomiting, diarrhea, and abdominal cramping		**vomiting, diarrhea, and abdominal cramping
	*Neurologic symptoms		*Neurologic symptoms
	**Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, and hot/cold temperature reversal		**Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, respiratory paralysis, ataxia, vertigo, and hot/cold temperature reversal
	*Cardiovascular symptoms		*Cardiovascular symptoms
	**Bradycardia, heart block, and hypotension.		**Bradycardia, heart block, pulmonary edema, and hypotension.

	==Differential Diagnosis==		==Differential Diagnosis==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-21T16:23:22Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 16:23, 21 July 2016
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	{{Marine envenomation DDX}}		{{Marine envenomation DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Clinical diagnosis		*Clinical diagnosis

Mholtz at 04:15, 4 April 2016

2016-04-04T04:15:31Z

← Older revision		Revision as of 04:15, 4 April 2016
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	**Antiemetics and IVF		**Antiemetics and IVF
	**Atropine for bradycardia		**Atropine for bradycardia
	*[[Mannitol]]		*[[Mannitol]] - Recommended by several experts for neurologic symptoms if given within 24-48 hours of onset <ref>Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479 </ref>. However, no benefit over normal saline in RCT<ref>Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873</ref>
	**Recommended by several experts for neurologic symptoms if given within 24-48 hours of onset <ref>Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479 </ref>. However, no benefit over normal saline in RCT<ref>Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873</ref>		**Caution: patients may be hypovolemic due to vomiting/diarrhea and should be appropriately volume resuscitated prior to considering mannitol
	**Caution ~~that many~~ patients may be hypovolemic 2/~~2 GI symptoms~~ and should be appropriately volume resuscitated prior to considering mannitol
	*[[Amitriptyline]] reported effective for neuropathic pain in several case series<ref>Lange W et al. Travel and ciguatera fish poisoning. Arch. Int. Med. 1992; 152:2049-2052</ref> <ref> Davis RT and Villar LA. Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 1986; 315:65</ref>		*[[Amitriptyline]] reported effective for neuropathic pain in several case series<ref>Lange W et al. Travel and ciguatera fish poisoning. Arch. Int. Med. 1992; 152:2049-2052</ref> <ref> Davis RT and Villar LA. Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 1986; 315:65</ref>
	*[[Gabapentin]]<ref> Perez CM et al. Treatment of ciguatera poisoning with gabapentin. N Engl J Med 2001; 344:692 </ref> and [[Pregabalin]] <ref> Brett J and Murnion B. Pregabalin to treat ciguatera fish poisoning. Clinical toxicology 2015; 53(6):588. </ref> also reported to control neurologic symptoms		*[[Gabapentin]]<ref> Perez CM et al. Treatment of ciguatera poisoning with gabapentin. N Engl J Med 2001; 344:692 </ref> and [[Pregabalin]] <ref> Brett J and Murnion B. Pregabalin to treat ciguatera fish poisoning. Clinical toxicology 2015; 53(6):588. </ref> also reported to control neurologic symptoms

Mholtz at 04:14, 4 April 2016

2016-04-04T04:14:18Z

← Older revision		Revision as of 04:14, 4 April 2016
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	==Background==		==Background==
	*Caused by eating fish contaminated with a heat-stable toxin, which is obtained by the fish ~~consuming~~ dinoflagellates that grow on and around coral reefs		*Caused by eating fish contaminated with a heat-stable toxin, which is obtained when the fish consumes dinoflagellates that grow on and around coral reefs
	*Most cases occur in the tropics and subtropics, between 35 degrees north and south latitudes		*Most cases occur in the tropics and subtropics, between 35 degrees north and south latitudes
	*Most common fish include barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper		*Most common fish include barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper
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	==Clinical Features==		==Clinical Features==
	*GI symptoms		*GI symptoms (~3-30 hours after consumption)
	**vomiting, diarrhea, and abdominal cramping		**vomiting, diarrhea, and abdominal cramping
	**3-30hrs after eating contaminated fish
	*Neurologic symptoms		*Neurologic symptoms
	**Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, and hot/cold temperature reversal		**Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, and hot/cold temperature reversal
Line 23:		Line 22:

	==Management==		==Management==
	*Symptomatic		*Symptomatic therapies are the mainstay of treatment
	**[[Mannitol]]		**Antiemetics and IVF
	***Recommended by several experts for neurologic symptoms if given within 24-48 hours of onset <ref>Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479 </ref>. However, no benefit over normal saline in RCT<ref>Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873</ref>
	***Caution that many patients may be hypovolemic 2/2 GI symptoms and should be appropriately volume resuscitated prior to considering mannitol
	**[[Neuropathic pain]]
	***[[Amitriptyline]] reported effective in several case series<ref>Lange W et al. Travel and ciguatera fish poisoning. Arch. Int. Med. 1992; 152:2049-2052</ref> <ref> Davis RT and Villar LA. Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 1986; 315:65</ref>
	***[[Gabapentin]]<ref> Perez CM et al. Treatment of ciguatera poisoning with gabapentin. N Engl J Med 2001; 344:692 </ref> and [[Pregabalin]] <ref> Brett J and Murnion B. Pregabalin to treat ciguatera fish poisoning. Clinical toxicology 2015; 53(6):588. </ref> also reported to control neurologic symptoms
	**Antiemetics and IVF ~~for hypotension~~
	**Atropine for bradycardia		**Atropine for bradycardia
	*~~Prevent recurrances~~		*[[Mannitol]]
	**Do not ingest alcohol, caffeine, nuts or fish for 6 months		**Recommended by several experts for neurologic symptoms if given within 24-48 hours of onset <ref>Friedman MA et al. Ciguatera Fish Poisoning: Treatment, Prevention, and Management. Marine Drugs 2008; 6:456-479 </ref>. However, no benefit over normal saline in RCT<ref>Schnorf H et al. Ciguatera Fish Poisoning. A double-blind randomized trial of mannitol therapy. Neurology 2002; 58(6):873</ref>
			**Caution that many patients may be hypovolemic 2/2 GI symptoms and should be appropriately volume resuscitated prior to considering mannitol
			*[[Amitriptyline]] reported effective for neuropathic pain in several case series<ref>Lange W et al. Travel and ciguatera fish poisoning. Arch. Int. Med. 1992; 152:2049-2052</ref> <ref> Davis RT and Villar LA. Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 1986; 315:65</ref>
			*[[Gabapentin]]<ref> Perez CM et al. Treatment of ciguatera poisoning with gabapentin. N Engl J Med 2001; 344:692 </ref> and [[Pregabalin]] <ref> Brett J and Murnion B. Pregabalin to treat ciguatera fish poisoning. Clinical toxicology 2015; 53(6):588. </ref> also reported to control neurologic symptoms
			*Prevent recurrences - instruct patient to not ingest alcohol, caffeine, nuts or fish for 6 months

	==Disposition==		==Disposition==

Mholtz at 04:06, 4 April 2016

2016-04-04T04:06:22Z

← Older revision		Revision as of 04:06, 4 April 2016
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	==Background==		==Background==
	*Most cases tropics and subtropics, between 35 degrees north and south latitudes		*Caused by eating fish contaminated with a heat-stable toxin, which is obtained by the fish consuming dinoflagellates that grow on and around coral reefs
	*Most common fish ~~are~~ barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper		*Most cases occur in the tropics and subtropics, between 35 degrees north and south latitudes
	*Caused by fish eating dinoflagellates that grow on and around coral reefs and contain a heat-stable toxin		*Most common fish include barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper
	*Suspected cases should be reported to local department of health		*Suspected cases should be reported to local department of health
			*Neurologic symptoms typically resolve within days to weeks
			**Persist for months in 20%, and years in up to 2%

	==Clinical Features==		==Clinical Features==
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	==Disposition==		==Disposition==
	*Generally may be discharged		*Generally may be discharged

	~~==Prognosis==~~
	*Neurologic symptoms typically persist from a few days to several weeks
	*~20% of patients have symptoms that persist for months
	*<2% have symptoms that last for years

	==See Also==		==See Also==