ciguatera poisoning

a poisoning resulting from eating ciguatoxic fishes (or sometimes algae or invertebrates), with tens of thousands of cases each year. Symptoms 3-5 hours after ingestion usually include abdominal pain, nausea, vomiting, watery diarrhoea, and numbness and tingling in the mouth region which spreads to the extremities. Acute symptoms disappear in 8-10 hours, most in 24 hours in moderate cases. In severe cases weakness, visual disturbances, skin disorders, temperature perception reversals, coma and even death (up to 20% mortality) may occur. Death appears to result from asphyxia. The toxin appears to be an "irreversible" anticholinesterase. An attack does not impart immunity. Diagnosis should be confirmed by history of ingestion and by the observation of the effect of atropine (will cause marked atropinization unless anticholinesterase intoxication is present) and by the estimation of acetylcholinesterase level in red blood cells. Treatment consists of artificial respiration with oxygen added as needed, atropinization (after recovery from cyanosis), dosing with protopam chloride and indicated symptomatic measures. The stomach should be emptied by gastric lavage, emetics or saline purges as soon as possible