II. Pathophysiology
- Consumption of shellfish (mussels, clams) containing Domoic Acid
- Effects are seen in humans as well as marine animals including birds
III. Mechanism
- Domoic Acid is produced by Pseudo-Nitzschia Diatoms (marine algae)
- Shellfish that filter feed (e.g. mussels, clams) accumulate the Domoic Acid toxin
- Domoic Acid is a non-protein Amino Acid
- Tasteless and odorless
- Heat stable
- Water soluble
- Domoic Acid is a Neurotoxin
IV. Findings
- Domoic Acid onset of activity within 5 hours of ingestion
- Gastrointestinal
- Abdominal Pain and cramping
- Nausea or Vomiting
- Diarrhea
- Neurologic
- Confusion and Disorientation to coma
- Memory Loss
- Hemiparesis
- Cranial Nerve palsy (e.g. Ophthalmoplegia)
- Purposeless chewing or grimacing
- Seizures or Status Epilepticus
- Cardiovascular
- Cardiac Dysrhythmia
- Hemodynamic instability
V. Evaluation
- See Unknown Ingestion
- See Altered Level of Consciousness
- Bedside Glucose
- Comprehensive metabolic panel
- Toxicology Screening
- Electrocardiogram
- CT Head
- Leftover Shellfish can be tested for toxins (ELISA, Liquid chromatography)
VI. Management
- Consider alternative diagnoses (see evaluation above)
- Supportive Care
- Intravenous Fluids
- Antiemetics
- Status Epilepticus management
- Vasopressors for refractory Hypotension
- Disposition
- Observe all patients with unclear cause, neurologic deficit, cardiovascular instability or Electrolyte abnormality
- Patients with mild symptoms may be discharged with close interval follow-up
VII. Complications
- Death (2%)
- Mortality is primarily in elderly
-
Seizures
- Resolve over weeks in most cases
- Persistent Neurologic Deficits (<10%)
VIII. Resources
- Amnesic Shellfish Poisoning (Washington Department of Health)
- Amnesic Shellfish Poisoning (Wikipedia)
IX. References
- Koch and Tomaszewski (2018) Crit Dec Emerg Med 32(5): 32
- Jeffery (2004) Food Chem Toxicol 42(4):545-57 +PMID:15019178 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C012301 |
| SnomedCT | 67938008 |
| English | 3-pyrrolidineacetic acid, 2-carboxy-4-(5-carboxy-1-methyl-1,3-hexadienyl)-, (2S-(2 alpha,3 beta,4 beta(1E,3E,5R*)))-, domoic acid, Amnesiac shellfish poison, amnesic shellfish poison, Amnesic shellfish poisoning, Amnesic shellfish poison, Domoic acid, Amnesic shellfish poison (substance), Demoic acid |
| Spanish | veneno amnésico de los mariscos (sustancia), veneno amnésico de los mariscos, veneno amnésico de los moluscos, ácido domóico |
Ontology: Amnesic Shellfish Poisoning (C0521825)
| Definition (MSH) | A condition caused by ingestion of shellfish contaminated by domoic acid-producing diatoms of the genus Pseudo-nitzschia. |
| Concepts | Injury or Poisoning (T037) |
| MSH | D057096 |
| SnomedCT | 95878009 |
| English | Shellfish Poisoning, Amnesic, Amnesic Shellfish Poisonings, Shellfish Poisonings, Amnesic, Amnesic Shellfish Poisoning, Poisoning, Amnesic Shellfish, Poisonings, Amnesic Shellfish, Amnesic shellfish poisoning, Amnesic shellfish poisoning (disorder) |
| French | IAC (Intoxication Amnésique par Coquillages), IAFM, Intoxication amnésique par coquillages, Intoxication amnésiante par coquillages, Intoxication amnésique par fruits de mer, Intoxication amnésiante par fruits de mer |
| German | Amnestische Schalentiervergiftung |
| Czech | měkkýši, korýši - amnestická otrava |
| Italian | Avvelenamento amnesico da molluschi |
| Norwegian | ASP–skalldyrforgiftninger |
| Spanish | intoxicación amnésica por mariscos (trastorno), intoxicación amnésica por mariscos |
