Following lavage, activated charcoal is reported to effectively bind the toxin. Gastric lavage (stomach washing) with an alkaline solution has been suggested, as well as endoscopy to remove the poison from the proximal small bowel. If spontaneous vomiting does not occur, it should be induced. There is no antidote for fugu poisoning, therefore treatment is limited to supportive measures and the removal of the unabsorbed toxin. Ill persons should be advised to proceed to a hospital emergency department and contact their local poison control center. Definitive diagnosis can only be made in a medical laboratory by examination of the ingested fish and identification of the specific toxins.
EATING FUGU SKIN
The initial diagnosis is usually made by observation of early symptoms, including an abnormal or unexplained tingling, pricking, or burning sensation on the skin around the mouth and throat. In several cases, people died within 17 minutes after eating pufferfish.
In severe cases, ataxia (the inability to coordinate the movements of muscles), muscle weakness, hypotension (low blood pressure) and cardiac arrhythmias (irregular heartbeat) may develop, followed by muscle twitching and respiratory paralysis, and death can occur. These symptoms usually occur 30 minutes to two hours after ingestion of the fish, depending on the amount of toxin ingested. The most common symptoms of fugu poisioning are tingling and burning of the mouth and tongue, numbness, drowsiness, and incoherent speech. The experience is expensive, however, since a plate of this delicacy can cost as much as $500. For this reason, eating fugu is considered an "experience," rather than just a meal in Japan. Part of the reported delight in eating fugu is the tingling oral sensation induced by minute amounts of tetrodotoxin in the flesh. The flesh of the fugu is generally eaten raw in paper-thin slices, known as sashimi. For these fish, tetrodotoxin may serve as a natural defense mechanism to repel predators. The fish appear to actively produce the toxin, rather than passively acquire it from the environment. Scientists have found that toxic fugu have unique exocrine glands for the secretion of tetrodotoxin. Fugu are found in waters throughout the world. In journals covering expeditions from 1772 –1775, Pacific explorer Captain James Cook provided a vivid description of what some believe to be puffer fish poisoning. Artifacts recovered from an Egyptian tomb indicate that puffer fish poisoning has been known since approximately 2400 –2700 B.C.
The dangers of puffer fish consumption have long been recognized. Since 1950, only three known fatalities have occurred in the United States, all in Florida. The earliest cases reported to the CDC involved poisonings in Florida during the mid-1970s. Cases of fugu poisoning are sporadically diagnosed, but many more are not recognized or reported. Tetrodotoxin has been detected in pufferfish throughout the Pacific Ocean and the Baja California coastal region. waters, such as the Gulf of Mexico, may also be toxic. All of the fish came from the Atlantic Ocean off the coast of Titusville, Florida. All persons recovered from the poisonings. Between January 1 and April 1, 2002, at least 10 cases of fugu poisoning were reported in the United States, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. The fugu and related species may contain a tetrodotoxin, an extremely potent neurotoxin and one of the most toxic substances known, which produces critical illness and often death. Descriptionįugu, also known as puffer fish, blowfish, or globefish, has long been a food delicacy in Japan, but has only been introduced in the United States in the last 30-40 years. Fugu poisoning occurs when a person eats the flesh of a fugu, also known as a puffer fish, which contains lethal toxins.
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