Last reviewed: 25 Oct 2020
Last updated: 02 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • oral numbness
  • dysphagia
  • dysarthria (common)
  • nausea (saxitoxin, tetrodotoxin)
  • vomiting (saxitoxin, tetrodotoxin)
  • diarrhoea (saxitoxin, tetrodotoxin)
  • weakness
  • ataxia/incoordination
  • hypertension (saxitoxin)
  • extreme pain (conotoxin)
  • hypotension or cardiovascular instability

Other diagnostic factors

  • light-headedness/dizziness
  • postural near-syncope/syncope
  • anxiety
  • loss of airway-protective reflexes
  • loss of adequate ventilation
  • hypoxia
  • bradycardia
  • apnoea
  • ventricular dysrhythmias

Risk factors

  • warmer waters
  • shellfish ingestion (saxitoxin)
  • xanthid crab ingestion (saxitoxin)
  • seafood ingestion (tetrodotoxin)
  • handling of blue-ringed octopus (tetrodotoxin)
  • handling of cone snail shells (conotoxin)
  • exposure to toxins in research/laboratory settings
  • bioterrorism

Diagnostic investigations

Investigations to consider

  • pulse oximetry
  • capnography
  • serial pulmonary function tests
  • arterial blood gases
  • chest x-ray
  • CT brain
  • serum electrolytes
  • high-performance liquid chromatography in flesh of seafood
More investigations to consider

Emerging tests

  • serum/urine toxin analysis
More emerging tests

Treatment algorithm

Contributors

Emergency Services Institute and International Operations

The Cleveland Clinic

Cleveland

OH

Disclosures

WTH is the author of a reference cited in this topic.

Medical Toxicology Fellow

California Poison Control System, SF Division

University of California San Francisco

San Francisco

CA 

Disclosures

JAL declares that he has no competing interests.

Dr William T. Hurley and Dr Jacob A. Lebin would like to gratefully acknowledge Dr Arvin Akhavan, a previous contributor to this topic. AA declares that he has no competing interests.

Peer reviewersVIEW ALL

Clinical Faculty

Rocky Mountain Poison and Drug Center

Denver

CO

Disclosures

SDP declares that he has no competing interests.

Professor of Pediatrics

University of Miami

Miller School of Medicine

Director

Florida Poison Center - Miami

Miami

FL

Disclosures

RSW declares that he has no competing interests.

Professor of Clinical Pharmacology and Toxicology

University of Sydney

Sydney

Australia

Disclosures

NB declares that he has no competing interests.

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