Emergency Medicine Book

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Scombroid Fish Poisoning

Aka: Scombroid Fish Poisoning, Scombroid Poisoning, Scombroid Toxicity
  1. Epidemiology
    1. More common in Hawaii and California
  2. Pathophysiology
    1. Improper handling of fish (delay to refrigeration)
      1. Unrefrigerated Tuna, Mahi-mahi,or mackerel
    2. Histidine converted to histamine by marine bacteria
    3. Isoniazid potentiates this reaction
  3. Symptoms (Related to histamine release)
    1. Severe Flushing
    2. Nausea
    3. Vomiting
    4. Diarrhea
    5. Severe Headache
    6. Palpitations
    7. Abdominal Pain
    8. Urticaria
  4. Course
    1. Onset within 20-30 minutes of ingestion
    2. Resolves within 6-8 hours
  5. Management
    1. Diphenhydramine (Benadryl) 50 mg IV/IM}PO
    2. Consider H2 Receptor Blocker (Ranitidine, Cimetidine)
    3. Consider inducing Emesis in severe cases

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