Puffer fish poisoning has been documented rarely in Australia. It results from ingesting tetrodoxtoxin found in the liver, ovaries, intestines and skin of the fish. Over a recent 16-month period, 11 cases of puffer fish poisoning were reported to the NSW Poisons Information Centre. Symptoms of poisoning may include paralysis, respiratory failure, numbness, paraesthesia, nausea and ataxia. Health professionals should be aware of the condition so as to institute early and appropriate management. (MJA 2002; 177: 650-653)
Tetrodotoxin (TTX) is present in high concentrations in the liver, ovaries, intestines and skin of puffer fish (Box 1).1 Although TTX poisoning caused by ingestion of the fish is common in some parts of the world, it occurs only sporadically in Australia, with only 16 published cases reported over the past 200 years.2-7 (This figure does not include the 11 cases described here.) One of the earliest descriptions of puffer fish poisoning in this region can be found in Captain James Cook's journal from his second voyage in 1774 (see Time Capsule, page 653).3
- 1. Tsunenari S, UchimuraY, Kanda M. Puffer poisoning in Japan — a case report. J Forensic Sci 1980; 25: 240-245.
- 2. Ellis RM, Jelinek GA. Never eat an ugly fish: three cases of tetrodotoxin poisoning from Western Australia. Emerg Med 1997; 9: 136-142.
- 3. Torda TA, Sinclair E, Ulyatt DB. Puffer fish (tetrodotoxin) poisoning: clinical record and suggested management. Med J Aust 1973; 1: 599-602.
- 4. Field J. Puffer fish poisoning. J Accid Emerg Med 1998; 15: 334-336.
- 5. Duncan C. A case of toadfish poisoning. Med J Aust 1951; 2: 673-675.
- 6. Tibballs J. Severe tetrodotoxic fish poisoning. Anaesth Intensive Care 1988; 16: 215-217.
- 7. Cleland JB. Injuries and diseases in Australia attributable to animals (except insects). Med J Aust 1924; 2: 339-345.
- 8. Kanchanapongkul J. Puffer fish poisoning: clinical features and management experience in 25 cases. J Med Assoc Thai 2001; 84: 385-389.
- 9. Yang CC, Liao SC, Deng JF. Tetrodotoxin poisoning in Taiwan: an analysis of poison center data. Vet Hum Toxicol 1996; 38: 282-286.
- 10. Kan SK, Chan MK, David P. Nine fatal cases of puffer fish poisoning in Sabah, Malaysia. Med J Malaysia 1987; 42: 199-200.
- 11. Meier J, White J, editors. Handbook of clinical toxicology of animal venoms and poisons. Boca Raton, Florida: CRC Press, 1995: 75-83.
- 12. Fukuda A, Tani A. Records of puffer poisonings. Report 3. Nippon Igaku Oyobi Kenko Hoken 1941; (3528): 7-13.
- 13. Kiernan MC, Bostock H. Effects of membrane polarization and ischaemia on the excitability properties of human motor axons. Brain 2000; 123(Pt 12): 2542-2551.
- 14. Kiernan MC, Burke D, Andersen KV, Bostock H. Multiple measures of axonal excitability: a new approach in clinical testing. Muscle Nerve 2000; 23: 399-409.
- 15. Kiernan MC, Lin CS, Andersen KV, et al. Clinical evaluation of excitability measures in sensory nerve. Muscle Nerve 2001; 24: 883-892.
- 16. Kiernan MC, Cikurel K, Bostock H. Effects of temperature on the excitability properties of human motor axons. Brain 2001; 124: 816-825.
- 17. Burke D, Mogyoros I, Vagg R, Kiernan MC. Temperature dependence of excitability indices of human cutaneous afferents. Muscle Nerve 1999; 22: 51-60.
- 18. Pearn J. Neurology of ciguatera. J Neurol Neurosurg Psychiatry 2001; 70: 4-8.
- 19. Kao CY. Tetrodotoxin, saxitoxin and their significance in the study of excitation phenomena. Pharmacol Rev 1966; 18: 997-1049.
- 20. Oda K, Araki K, Totoki T, Shibasaki H. Nerve conduction study of human tetrodotoxication. Neurology 1989; 39: 743-745.
- 21. Yamazaki M, Shibuya N. Motor nerve conduction velocity is useful for patients with tetrodotoxin. Anesth Analg 1995; 80: 857.
- 22. Anderson WH. Tetrodotoxin and the zombi phenomenon. J Ethnopharmacol 1988; 23: 121-126.
- 23. Littlewood R, Douyon C. Clinical findings in three cases of zombification. Lancet 1997; 350: 1094-1096.
- 24. Burke D, Kiernan MC, Bostock H. Excitability of human axons. Clin Neurophysiol 2001; 112: 1575-1585.
- 25. Schwarz JR, Reid G, Bostock H. Action potentials and membrane currents in the human node of Ranvier. Pflugers Arch 1995; 430: 283-292.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.