Puffer fish poisoning: a potentially life-threatening condition

Geoffrey K Isbister, Julie Son, Josef Ujma, Brendon Smith, D G Milder, Frank Wang, Catriona J Maclean, Cindy S-Y Lin, Matthew C Kiernan and Corrine R Balit
Med J Aust 2002; 177 (11): . || doi: 10.5694/j.1326-5377.2002.tb04999.x
Published online: 9 December 2002

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 Discipline of Clinical Pharmacology, University of Newcastle, Waratah, NSW.
  • 2 Bankstown–Lidcombe Hospital, Bankstown, NSW.
  • 3 St George Hospital, Kogarah, NSW.
  • 4 Liverpool Hospital, Liverpool, NSW.
  • 5 Prince of Wales Medical Research Institute, University of New South Wales, Randwick, NSW.
  • 6 NSW Poisons Information Centre, The Children's Hospital, Westmead, NSW.



We would like to thank Doug Hoese and Mark McGrouther from the Australian Museum for providing information on puffer fish. We also acknowledge Erik Schlogl for supplying the photograph of the common toadfish. We thank Lindsay Murray for providing the contact details for Case 1.

Competing interests:

None identified.

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