Tetrodotoxin poisoning : a clinical analysis , role of neostigmine and short-term outcome of 53 cases

Introduction: Puffer fi sh (tetrodotoxin) poisoning is now a common form of poisoning throughout coastal countries, but its diagnosis and management are still unclear. In this paper, we aim to share our experience and to fi nd out the toxic manifestations, lag period between ingestion of fi sh and development of symptoms, the short-term clinical outcome, and value of neostigmine in its management. Methods: The study was carried out in the Department of Medicine and Paediatrics, Khulna Medical College Hospital, Khulna, Bangladesh, from May 1, 2001 to May 1, 2006. A total of 53 patients were admitted with the history of puffer fi sh ingestion. All the cases were clinically analysed from admission to discharge, for the following variables: Onset of symptoms in minutes after the ingestion of fi sh, toxic manifestations that developed after ingestion, relation of clinical outcome with approximate amount of fi sh ingested, and the role of neostigmine. Results: All patients developed toxic manifestation. Important symptoms were perioral paraesthesia (38), weakness of all limbs (33), paraesthesia all over the body (34), headache (25), and diffi culty in respiration. Eight patients died, probably due to respiratory muscle paralysis, of which fi ve patients died immediately after admission. We used neostigmine in those patients who developed respiratory failure. 13 patients improved signifi cantly (p-value is less than 0.5), while only three patients died. Conclusion: Because of the availability and affordability of puffer fi sh, the occurrence of tetrodotoxin poisoning throughout coastal countries is very likely. Therefore, health personnel should have enough knowledge regarding its toxic manifestations and management.