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
1st investigations to order
- clinical diagnosis
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
Emerging tests
- serum/urine toxin analysis
Treatment algorithm
all patients
Contributors
Authors
William T. Hurley, MD, MBA, FACEP, FACMT
Emergency Services Institute and International Operations
The Cleveland Clinic
Cleveland
OH
Disclosures
WTH is the author of a reference cited in this topic.
Jacob A. Lebin, MD
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.
Acknowledgements
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 reviewers
Scott D. Phillips, MD, FACP, FACMT, FAACT
Clinical Faculty
Rocky Mountain Poison and Drug Center
Denver
CO
Disclosures
SDP declares that he has no competing interests.
Richard S. Weisman, Pharm.D., DABAT, FAACT
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.
Nick Buckley, MD, FRACP
Professor of Clinical Pharmacology and Toxicology
University of Sydney
Sydney
Australia
Disclosures
NB declares that he has no competing interests.
Differentials
- Food poisoning (other causes)
- Viral gastroenteritis
- Anxiety/panic episode
More DifferentialsGuidelines
- Clinical practice guidelines: toxicology and toxinology - marine envenomation
- Clinical practice guidelines: toxicology and toxinology - marine envenomation
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer