Ciguatera fish Poisoning: a Challenge to Emergency Physicians

Abstract

Seven patients from two families presented with ciguatera poisoning after fish consumption. They suffered most of the typical clinical features of ciguatera poisoning and were given supportive treatments. Three of them were given mannitol infusion and showed improvement in symptoms. All of them were discharged within two days.

A Review of Traditional Remedies of Ciguatera Fish Poisoning in the Pacific

“…atropine is generally used. In cases of shock, mechanical circulatory support including positive inotropic agents such as dopamine, adrenaline or calcium gluconate may be required (Baden et al, 1995;Cheng and Chung, 2004;Gillespie et al, 1986;Ruff and Lewis, 1994). Occasionally, in order to manage the dysrhythmias, temporary cardiac pacing may also be inserted (Friedman et al, 2008;Ruff and Lewis, 1994).…”

Ciguatera fish poisoning and other seafood intoxication syndromes: A revisit and a review of the existing treatments employed in ciguatera fish poisoning

“…The clinical presentation of CFP (Table 6) has been addressed in substantial detail by various authors around the world (Bagnis et al, 1979;Gillespie et al, 1986;Geller et al, 1991;Katz et al, 1993;Ruff and Lewis, 1994;de Haro et al, 1997;2003;Lehane and Lewis, 2000;Ng and Gregory, 2000;Farstad and Chow, 2001;Goodman et al, 2003;Arena et al, 2004;Cheng and Chung, 2004;Laurent et al, 2005;Kipping et al, 2006;Nicholson and Lewis, 2006;Dickey, 2008;Friedman et al, 2008). Globally more than 175 acute and chronic gastrointestinal, neurological and/or generalized disturbances, and to a lesser extent, cardiovascular symptoms have been described (Wang, 2008).…”

“…Gastrointestinal symptoms, usually brief and self-limited, require little more than intravenous (i.v.) fluid and electrolyte replacement (Gillespie et al, 1986;Cheng and Chung, 2004). In the acute phase of the intoxication activated charcoal, believed to bring some benefit through toxin elimination by absorption, may be administrated.…”

“…In the absence of these symptoms, emetics and cathartics are administrated (Gillespie et al, 1986). On the other hand, in certain cases, antiemetic and anti-diarrhea medications may also be prescribed to contain severe gastrointestinal manifestations (de Haro et al, 2003;Cheng and Chung, 2004). For the palliative wellbeing cold showers to relieve pruritus and bed rest during period of convalescence are also indicated.…”

“…In cases of cardiovascular disorders, atropine is generally used to alleviate hypotension and bradycardia but it has no effect on the neurological or gastrointestinal disturbances. In severe cases, dopamine or adrenaline or calcium gluconate may be required (Baden et al, 1995;Cheng and Chung, 2004;Nicholson and Lewis, 2006). Rarely, critically ill CFP patients may require endotracheal intubation and mechanical ventilation for either airway protection if comatose or in the case of a respiratory failure.…”