Management of puffer fish poisoning.

Sir,—I was interested in the recent review article on animal toxins by Karalliedde [1]. In Hong Kong puffer fish poisoning occurs sporadically. The most important management is early intubation and assisted ventilation for cases with respiratory failure and circulatory support, with fluid and inotropes for hypotensive patients. Although there is no specific antidote for the tetro-dotoxin, certain measures may also be useful in the treatment of such poisoning. Removal of unabsorbed toxin by gastric lavage with 2 % sodium bicarbonate is useful as tetrodotoxin is less stable in an alkaline solution [2]. Anticholinesterase drugs such as edrophonium and neostigmine, especially if given early in these poisoning, have been effective in reversing the muscle weakness and hastening spontaneous recovery [3–7]. Cysteine, by opening sodium channels, has been used to antagonize the blocking effect of tetrodotoxin on nerve conduction [2, 8]. However, the roles of anticholinesterases and cysteine in the management of puffer fish poisoning remain uncertain [9, 10] and more clinical studies are required to confirm their therapeutic efficacy. diagnosis and management of mild human tetrodotoxication. fish (tetrodotoxin) poisoning: clinical report and role of anti-cholinesterase drugs in therapy. Cysteine sufinic acid-induced release of D-[ 3 H] aspartate and [ 14 C] GABA in hippocampus slices: the role of sodium channels and cAMP. Sir,—Tetrodotoxin (TTX) causes interruption of neuromuscular transmission at the motor axons and the muscle membranes. Although during partial block it is possible to elicit brief tetanic contraction by increasing the frequency of stimulation, or elicit a contraction by perfusing acetylcholine into the arterial supply of muscle, when TTX produces a complete block neither has any effect. Neostigmine and edrophonium do not antagonize the block [1, 2]. The apparent benefit of anticholinesterases observed by some workers would have been in situations of partial block, and obviously therefore_clinical results have been conflicting [3]. However, as there is no specific antidote, any therapeutic measure that brings about improvement may be attempted. Anti-cholinesterases have no effect on the other systems affected by TTX. It was beyond the scope of the review to discuss in detail all forms of therapy that have been found to be of benefit empirically. If one were to speculate, aminopyridine may be more effective in situations of partial block. 1. Kao CY, Furhman FA. Pharmacological studies on tetrodo-toxin, a potent neurotoxin. Tramadol Sir,—Following the editorial on tramadol by Eggers and Power [1], I wish to comment on their mention …