not to be confused with [[Marine Envenomation]] #TOXINology see: [Dunn Toxic Marine ingestions](x-devonthink-item://E10909BD-9785-4ABB-9BB0-DCFEFBFE76BA) # Ciguatera poisoning - commonest marine poisoning - *gamberidiscus toxicus dinoflagellates* produce **ciguatoxin** (a neurotoxin) - passes up food chain → algae → fish → consumed by humas - coral trout, barracuda, spanish mackerel - usually in Queensland *Ciguatoxin* - not inactivated by cooking or freezing, ∴ outbreaks may occur inland - binds to voltage-sensitive Na channels causing prolonged opening → Na influx → depolarisation - effects neurons, skeletal muscle, cardiac tissue - most effects in neurotoxin - **no antitoxin** **effects** - 4-6 hours following ingestion of fish - GIT -- nausea, vomiting, diarrhoea , abdo pain - next neuro sx - myalgias, paraesthesias (numb lips and limbs), cold allodynia - pruritis, rash - sweating, myalgias, arthralgias, muscle cramps, bizarre taste **management** - supportive and symptomatic care - IVF if dehydration - antihistamines for pruritis - no charcoal - not for mannitol (outdated treatment) **dispo** - symptoms usually 2-5 days - most disease mild and self-limited - generally fully-recover in 2 weeks - sensory disturbances may persist weeks - months # Shellfish poisoning - paralytic shelfish poisoning : saxitoxin - amnestic shellfish poisioning: domoic acid - abdo pain, cramps, confussion, memory loss, confusion # Scrombroid poisoning - usually consumption of tuna, mackeral - metabolic products of bacterial degradation of blue fish flesh - symptoms due to *histamine* release (formed from histadine when fish not preserved properly) - similar symptoms to IgE-mediated food allergies **assessment** - usually 20-30 min after ingestion - flushing - headache, dizziness - swelling - nausea, vomiting - diarrhoea - abdo pain - occasionally urticaria, pruritis **management** - mild cases no treatment - antihistamines H1 and H2 blockers - bronchodilators for bronchospasm - +/- adrenaline if not sure about anaphylaxis **dispo** - usually self limited illness sx subsiding over 6-24 hours