Emergency Medicine Book

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Ciguatera PoisoningAka: Ciguatera Toxin, Ciguatoxin

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  1. Epidemiology
    1. Reaction occurs in up to 90% of ciguatoxin ingestions
    2. Most common outbreaks
      1. Florida
      2. Hawaii
      3. West Indies
      4. Puerto Rico
      5. U.S. Virgin Islands
  2. Pathophysiology
    1. Gambierdiscus toxicus bioaccumulates in reef fish
    2. Reef fish ingestion results in reaction
      1. Amberjack
      2. Grouper
      3. Snapper
      4. Sturgeon
      5. King Mackerel
      6. Barracuda
      7. Moray eel
  3. Symptoms: Anticholinergic reaction
    1. Gastrointestinal
      1. Nausea or Vomiting
      2. Voluminous, watery Diarrhea
      3. Abdominal Pain
    2. Neurologic
      1. Cold-hot sensation reversal
        1. Occurs in 80% of cases
        2. Pathognomonic for Ciguatera toxin
      2. Numbness or Paresthesias
      3. Vertigo or ataxia
      4. Weakness
      5. Myalgias
    3. Cardiopulmonary changes
      1. Bradycardia
      2. Hypotension
  4. Course
    1. Anticholinergic Symptoms 3-6 hours after ingestion
      1. Reactions delayed up to 24 hours in some cases
    2. Symptom duration: 7 to 14 days
    3. More severe cases with prior ciguatoxin reactions
  5. Management
    1. Supportive care
    2. May require pressors for hypotension
    3. May require Bradycardia management
    4. Mannitol does not appear effective in shortening course
      1. Schnorf (2002) Neurology 58:873
  6. Prevention
    1. Avoid ingestion of large warm-water reef fish
    2. Limit intakes to small quantities
    3. Avoid ingesting internal organs of fish
    4. No food preparation method deactivate ciguatoxin
  7. References
    1. Perkins (2004) Am Fam Physician 69(4):885

Ciguatera Poisoning (C0008775)

Definition (MSH)Poisoning caused by ingestion of SEAFOOD containing microgram levels of CIGUATOXINS. The poisoning is characterized by gastrointestinal, neurological and cardiovascular disturbances.
ConceptsInjury or Poisoning (T037)
EnglishCiguatera, ciguatera fish poisoning, Ciguatera Poisoning, Ciguatera Poisonings, Ciguatoxin causing toxic effect, Fish poisoning, Ichthyosarcotoxism, Poisoning by eating contaminated fish, Toxic effect of ciguatera fish poisoning
Spanishciguatera, ciguatoxina que causa efectos tóxicos, ciguatoxina que causa efectos toxicos, ictiosarcotoxicosis, intoxicación por ingestión de pescado contaminado, intoxicación por pescado, intoxicacion por ingestion de pescado contaminado, intoxicacion por pescado
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Ciguatoxins (C0008776)

Definition (MSH)Polycyclic ethers produced by Gambierdiscus (DINOFLAGELLATES) from gambiertoxins, which are ingested by fish which in turn may be ingested by humans who are susceptible to the CIGUATERA POISONING.
ConceptsBiologically Active Substance (T123) , Hazardous or Poisonous Substance (T131)
EnglishCiguatoxin, Ciguatoxins
Spanishciguatoxina
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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