Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 10/12/2021
Doctor's Notes on Ciguatera Fish Poisoning
Ciguatera is a type of food poisoning caused by eating fish contaminated by the ciguatera toxin found concentrated in fish organs. The toxin is commonly found concentrated in large reef fish, such as grouper, red snapper, sea bass, barracuda, eel, amberjack, and Spanish mackerel. Most fish that carry ciguatera toxin are found in the Caribbean Sea, Hawaii, and coastal Central America.
Symptoms of ciguatera fish poisoning (ciguatera toxin) usually begin 6 to 8 hours after eating contaminated fish but can occur anywhere from 2 to 24 hours after ingestion and include
- nausea,
- vomiting,
- diarrhea,
- muscle pain,
- numbness,
- tingling,
- abdominal pain,
- dizziness,
- spinning sensation (vertigo),
- feeling of hot and cold sensation reversal,
- feeling of teeth being loose, and
- itching.
Symptoms of severe ciguatera fish poisoning (ciguatera toxin) include
- shortness of breath,
- salivation,
- tearing,
- chills,
- rashes,
- itching,
- paralysis,
- slow heart rate,
- coma, and
- low blood pressure (hypotension).
What Is the Treatment for Ciguatera Fish Poisoning (Ciguatera Toxin)?
There is no specific antitoxin or antidote available for ciguatera toxin poisoning. Patients are given symptomatic and supportive care for the symptoms caused by ciguatera poisoning.
Symptomatic care for ciguatera poisoning may include:
- Intravenous fluids (IV) for dehydration from nausea, vomiting, and diarrhea
- Anti-nausea medications such as ondansetron (Zofran)
- Severe cases that include low heart rate or low blood pressure (hypotension) may require hospital monitoring and possibly admission to a hospital
- Osmotic diuretics such as mannitol (Osmitrol) may be used to decrease symptoms in longer term cases
- Amitriptyline (Elavil) and gabapentin (Neurontin) may help reduce nerve pain symptoms
- Diphenhydramine (Benadryl) and hydroxyzine (Atarax) to help relieve itching
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or other pain medication such as acetaminophen (Tylenol and others) may help reduce pain
- Avoid alcohol, fish, nuts, and nut oils after exposure to ciguatera toxin because they may trigger recurrent symptoms
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REFERENCE:
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.