Ciguatera: Difference between revisions
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*Cardiovascular symptoms | *Cardiovascular symptoms | ||
**Bradycardia, heart block, and hypotension. | **Bradycardia, heart block, and hypotension. | ||
*Suspected cases should be reported to local department of health | |||
^Diagnosis based on history and physical only | ^Diagnosis based on history and physical only | ||
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==Treatment== | ==Treatment== | ||
*Symptomatic | *Symptomatic | ||
**[[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 that many patients may be hypovolemic 2/2 GI symptoms and should be appropriately volume resuscitated prior to considering mannitol | |||
*Prevent recurrances | *Prevent recurrances | ||
**Do not ingest alcohol, caffeine, nuts or fish for 6 months | **Do not ingest alcohol, caffeine, nuts or fish for 6 months | ||
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==Source== | ==Source== | ||
UpToDate | UpToDate | ||
<references/> | |||
[[Category:Environ]] | [[Category:Environ]] | ||
Revision as of 22:05, 6 January 2016
Background
- Most cases tropics and subtropics, between 35 degrees north and south latitudes
- Most common fish are barracuda, moray eel, amberjack, and certain types of grouper, mackerel, parrotfish, and red snapper
- Caused by fish eating dinoflagellates that grow on and around coral reefs and contain a heat-stable toxin
Diagnosis
- GI symptoms
- vomiting, diarrhea, and abdominal cramping
- 3-30hrs after eating contaminated fish
- Neurologic symptoms
- Paresthesias, painful teeth, painful urination, blurred vision, nerve palsies, and hot/cold temperature reversal
- Cardiovascular symptoms
- Bradycardia, heart block, and hypotension.
- Suspected cases should be reported to local department of health
^Diagnosis based on history and physical only
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Treatment
- Symptomatic
- Prevent recurrances
- Do not ingest alcohol, caffeine, nuts or fish for 6 months
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
Source
UpToDate