Puffer Fish
...ythmia and speech impairment and finally, death. Death usually occurs within hours but some patients exist in zombie like states of suspended animation for days before experiencing complete recovery. During all of these events the patient remains completely lucid. Estimates are that as many as 200 cases of such poisonings a year with half of the victims dying. The culprit in these cases is a deadly poison found in the puffer fish-tetrodotoxin In some species the adults are known to poisonous due to the tetraodontoxin that is found in large concentrations in their organs. Even though this highly toxic substance is known to cause death many of these species are still eaten in some areas of the world. The liver, gonads, intestines, and skin of these fish contain tetrodotoxin, a powerful neurotoxin that can cause death in approximately 60% of persons who ingest it. Tetrodotoxin is heat-stable and blocks sodium conductance and neuronal transmission in skeletal muscles. Paresthesias begin 10-45 minutes after ingestion, usually as tingling of the tongue and inner surface of the mouth. Other common symptoms include vomiting, lightheadedness, dizziness, feelings of doom, and weakness. An ascending paralysis develops, and death can occur within 6-24 hours, secondary to respiratory muscle paralysis. Other manifestations include salivation, muscle twitching, diaphoresis, pleuritic chest pain, dysphagia, aphonia, and convulsions. Severe poisoning is indicated by hypotension, bradycardia, depressed corneal reflexes, and fixed dilated pupils. If cleaned and dressed properly, the fugu flesh or musculature is edible and considered a delicacy by some persons in Japan, who may pay the equivalent of $400 U.S. for one meal. Despi...