Puffer fish poisoning: four case reports.

SUMMARY Four cases of puffer fish poisoning with one death in a family are described. Acute respiratory cessation probably resulted from both depression of the medullary centres and muscular paralysis by the neurotoxin. Artificial ventilation is the single most effective therapeutic measure and should be considered in all severe cases. Delay in treatment may result in death. Anticholinesterases are not known to confer any benefit. Medical staff in coastal hospitals should familiarise themselves with the managementof puffer fish poisoning.