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Almost all Fish
Sting, they don’t bite
Intense pain (out of proportion to wound) and severe edema are the major symptoms common to the vast majority of fish envenomations
Systemic symptoms include ischemia, muscle spasms, tissue necrosis, prolonged weakness, nausea, paralysis of the affected limb, hallucinations, loss of perception, hypotension, tachycardia, and respiratory distress
Slow healing and necrosis have been observed
The extent of damage varies according to the species, number and depth of envenomation sites, and individual reaction to the venom component
Secondary infections are also known to occur, leading to additional damage
Fish poisonings
Ichthyosarcotoxism
puffer fish poisoning
Tetrodotoxin (TTX) is one of the strongest toxins known (see previous graphic)
Neurotoxin in fish liver, gonads, intestines & skin
Fish muscles are generally edible
Fugu is prepared in Japan by highly trained chefs & sold in special restaurants
Still number one cause of fatal food poisoning in Japan
First symptoms include tingling of lips & tongue (see last slide for more symptoms)
Fatal w/in 24 hours; case fatality rate is about 60%
No antidote; respiratory support until excreted in the urine
Activated charcoal and/or gastric lavage (stomach pumping) if patient presents within 60 minutes of ingestion
Ciguatera
ciguatoxin
Scombroid poisoning
histamine
Sea turtle poisoning
Tetrodotoxin
is a neurotoxin named after Tetraodontiformes, a fish order that includes puffers, porcupine fishes, blowfish, ocean sunfishes, triggerfish, and others
Also found in rough-skinned newts, frogs, toads, blue-ringed octopus, crabs, starfish, and flatworms
Tetrodotoxic Fishes
Multiple species in Order Tetraodontiformes
Puffers most common in tropics but extend into temperate zone (including US Atlantic Coast)
Puff up by swallowing air or water
Can also bite with large teeth or “beak”
Offensive odor