II. Epidemiology
- More common in Hawaii and California
III. Pathophysiology
- Improper handling of fish (delay to refrigeration, poorly refrigerated or inadequately frozen)
- Scombridae family or dark meat fish such as Tuna, Mahi-mahi,or mackerel
- Food typically tastes atypical
-
Histidine from fish Muscle is decarboxylated to Histamine by marine Bacteria
- Bacteria containing Histidine decarboxylase include Escherichia, Klebsiella, Proteus, Vibrio, Pseudomonas
- Isoniazid potentiates this reaction
IV. Causes: Scombridae Family Fish
- Mackerel
- Marlin
- Bonito Fish
- Yellowfin Tuna
- Albacore Tuna
- Skipjack Tuna
V. Symptoms (Related to Histamine release)
- Typical Histamine related response
- Severe Flushing including facial Flushing
- Diarrhea
- Palpitations
- Abdominal Pain
- Urticaria
- Bronchospasm with Wheezing
- Orthostatic Hypotension
- Bitter, pepper or Metallic Taste (Dysgeusia)
- Histamine-3 (H3) activity related symptoms
VI. Labs
- Avoid Histamine level (not useful)
-
Tryptase level
- May differentiate from Allergic Reactions
VII. Differential Diagnosis
VIII. Course
- Onset within 10-60 min (on average 20-30 min) of ingestion
- Resolves within 6-8 hours, up to 24 hours (rarely more)
IX. Management
- Avoid Gastric Decontamination in most cases
-
Antihistamine
- Diphenhydramine (Benadryl) 50 mg IV/IM}PO
- Consider H2 Receptor Blocker (Ranitidine, Cimetidine)
-
Nebulized Albuterol
- Indicated for bronchospasm
- Other symptomatic management
X. References
- Koch and Tomaszewski (2018) Crit Dec Emerg Med 32(1): 24
- Stratta (2012) Scombroid Poisoning 184(6):674 +PMID:22231690 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| ICD10 | T61.1 |
| SnomedCT | 212866009, 241773001, 83227006 |
| English | Scombroid fish caus tox effect, Toxic eff/scombroid fish poisn, scombroid poisoning (diagnosis), scombroid poisoning, scombroid fish poisoning, histamine fish poisoning, Scombroid fish causing toxic effect (event), Scombroid fish causing toxic effect (disorder), Scombroid fish poisoning, Histamine fish poisoning, Scombroid fish causing toxic effect, Toxic effect of scombroid fish poisoning, Scombroid fish poisoning (disorder), poisoning; scombroid fish, scombroid fish; poisoning |
| German | Scombroid-Fischvergiftung |
| Korean | 스콤브로이드 물고기 중독 |
| Dutch | scombroïdvis; vergiftiging, vergiftiging; scombroïdvis, Vergiftiging door scombroïdvis |
| Spanish | intoxicación por pescado escombroideo (trastorno), intoxicación por pescado escombroideo |
