Review
Neurotoxic marine poisoning
Summary
Marine
poisoning results from the ingestion of marine animals that contain
toxic substances and causes substantial illness in coastal regions.
Three main clinical syndromes of marine poisoning have important
neurological symptoms—ciguatera, tetrodotoxin poisoning, and paralytic
shellfish poisoning. Ciguatera is the commonest syndrome of marine
poisoning and is characterised by moderate to severe gastrointestinal
effects (vomiting, diarrhoea, and abdominal cramps) and neurological
effects (myalgia, paraesthesia, cold allodynia, and ataxia), but is
rarely lethal. Tetrodotoxin poisoning and paralytic shellfish poisoning
are less common but have a higher fatality rate than ciguatera. Mild
gastrointestinal effects and a descending paralysis are characteristic
of these types of poisoning. In severe poisoning, paralysis rapidly
progresses to respiratory failure. Diagnosis of all types of marine
poisoning is made from the circumstances of ingestion (type of fish and
location) and the clinical effects. Because there are no antidotes,
supportive care, including mechanical ventilation in patients with
severe paralysis, is the mainstay of treatment.
Article Info