Marine Poisoning & its management

Scombriod poisoning:

Scombriod fish (mackerel like) include bluefin and yellowfin tuna, albacore, needle fish, skipjack, bonito etc. non scombroid fishes can also contain scombrotoxin. Poisoning with scombrotoxin is called pseudoallergic fish poisoning.
Under inadequate refrigeration/preservation these fishes undergo baterial decomposition and formation of amino acid L- histidine to histamine, histamine phosphate, and hydrochloride. Histamine level of 20 to 50 mgs/100 gm of fish has been noted. But it may be as high as 400 mg/100 gm. The toxin is heat stable and not destroyed by cooking or heating. Affected fish is of typical taste, but it may be without any specific taste or odor. Distribution of poison may not be same, this explain why some people do not get sick after eating same fish.
Symptoms develop within 15 minutes to one hour. Itching, urticaria, flushing which is sharply demarketed, nausea, vomiting, diarrhea, abdominal cramps, epigastric pain, headache, difficulty in swallowing, thirst, burning of mouth, dizziness, high pulse rate, feeling of warmth without increase in core temperature. These symptoms may resolve without any treatment within a day.

Treatment include antihitaminics and symptomatic treatment.

Paralytic Shellfish Poisoning:

Paralytic Shellfish poisoning is induced by ingestion of aquacultured filterfeeding organisms like oysters, clams, starfish, mussels, scallops, and sand crabs etc. The toxin they have is accumulated by feeding the planktons where they live. The toxin is water soluble and heat stable. It can also kill large numbers of marine life. Commonest toxin is saxitoxin.

Symptoms appear within few minutes of ingestion of the toxin. It includes loss of sensation of tongue, lips, gums, which may progress rapidly to neck and extremities. Other symptoms include lightheadedness, incoordination, disequilibrium, incoherence, weakness, thirst, salivation, difficulty in swallowing, diarrhea, vomiting, abdominal pain, headache, loss of vision etc.

Treatment is supportive and based on symptoms.

Ciguatera poisoning:

Ciguatera poisoning is the commonest non bacterial food poisoning associated with fish in USA, most of the cases occurs in Florida and Hawaii. Poisoning involves tropical and subtropical coral reef fish. Poisoning involve five different types of toxins. These toxins are heat, cold, drying, and gastric acid resistant. These five toxins are colorless, tasteless, and odorless.

Symptoms occur within 15 to 30 minutes of ingestion. They include abdominal pain, diarrhea, vomiting, chills, itching, numbness of throat and tongue, sensation of carbonation during swallowing, tremor, fatigue, and headache.

Treatment is symptomatic and supportive. Activated charcoal (100 gm) in sorbitol is useful if given within three hours of ingestion of the toxin. Sedatives can be given if patient is apprehensive. Adequate hydration should be given if there is dehydration.

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