Tetrodotoxin

Aka: Tetrodotoxin, Puffer Fish Toxin, Fugu Toxin, Fugu Poison, Maculotoxin, Spheroidine

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II. Pathophysiology

  1. Tetrodotoxin (TTX) is a potent, often lethal toxin concentrated in liver and gonads of some fish, and the skin of freshwater fish
  2. Illness occurs after ingestion of improperly prepared fish
    1. TTX inhibits Sodium channels within Muscles and nerves with secondary Acute Respiratory Failure or Heart Failure

III. Causes

  1. Puffer Fish (most common source, esp. Fugu in Japan)
  2. Porcupine Fish
  3. Ocean sunfish
  4. Trigger Fish
  5. Globe Fish
  6. Toad Fish
  7. Octopus

IV. Symptoms

  1. Headache
  2. Paresthesias (Tongue, lips)
  3. Muscle Weakness
  4. Ataxia
  5. Vomiting

V. Management

  1. No commercially available antidote (although Monoclonal Antibody agents have been investigated)
  2. Consider Gastric Lavage
  3. Supportive care
    1. Respiratory support or Mechanical Ventilation

VI. Complications

  1. Respiratory Failure
  2. Heart Failure
  3. Death

VII. Resources

  1. Tetrodotoxin Toxicity (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK507714/

VIII. References

  1. Lago (2015) Mar Drugs 13(10): 6384-406 +PMID:26492253

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