injuries poisoning
Fish Poisoning and Shellfish Poisoning
Ciguatera poisoning
Ciguatera poisoning may result from eating any of>400 species of fish from the tropical reefs of Florida, the West Indies, or the Pacific, where a dinoflagellate produces a toxin that accumulates in the flesh of the fish. Older fish and large fish (eg, grouper, snapper, kingfish) contain more toxin. No known processing procedures, including cooking, are protective, and flavor is unaffected. Poisoning can occur after eating fresh or frozen fish. No commercial product is available to test for ciguatoxin in fish. Symptoms may begin 2 to 8 hours after eating. Abdominal cramps, nausea, vomiting, and diarrhea last 6 to 17 hours; then, pruritus, paresthesias, headache, myalgia, reversal of hot and cold sensation, and face pain may occur. For months afterward, unusual sensory phenomena and nervousness may cause debilitation. IVmannitolhas been suggested as a treatment, but no clear benefit has been shown. 