Symptoms and Signs of Pufferfish Poisoning

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 11/3/2021

Doctor's Notes on Pufferfish Poisoning

The poison found in pufferfish, blowfish, balloon fish, toads, sunfish, porcupine fish, toadfish, globefish, and swellfish is a tetrodotoxin, one of the most toxic poisons found in nature. Most people who eat pufferfish do so intentionally as pufferfish are considered an Asian delicacy, served in some types of sushi and sashimi. Unless the chef is specially trained to cut the meat in a particular fashion, the dish may contain a large amount of the toxin. 

Symptoms of pufferfish poisoning usually occur within 10-45 minutes after ingesting the pufferfish poison. Initial symptoms of pufferfish poisoning include

  • numbness and tingling around the mouth,
  • salivation,
  • nausea, and
  • vomiting.

Symptoms of pufferfish poisoning may progress to paralysis, loss of consciousness, and respiratory failure, and can lead to death. If pufferfish poisoning is suspected seek medical attention immediately. 

What Is the Treatment for Pufferfish Poisoning?

Pufferfish poisoning from ingestion of the toxin is a medical emergency. Poisonings are severe and deadly. Patients often need emergency critical care and monitoring. Medical care for a patient with pufferfish poisoning includes:

  • Induce vomiting if the poisoned person is awake and alert and has eaten the fish within 3 hours
  • Call 911 (or the equivalent in other countries) and get to an emergency department
  • The person may become paralyzed and artificial respiration may be needed
  • The patient may need charcoal to decontaminate the gastrointestinal (GI) tract of any remaining poison
  • Medications such as edrophonium or neostigmine may help reverse paralysis
  • Critical care monitoring, fluids, and other supportive care
  • Intubation and ventilatory support for patients not breathing on their own

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.