Archive for the ‘Poisons’ Category

New! From The Wilderness Medicine Newsletter

February 10, 2012

For decades the Wilderness Medicine Newsletter has provided up-to-date information to pre-hospital and definitive care providers. Since becoming an on-line journal, the readership of the WMN has become international. Now the WMN has it’s own web site: www.wildernessmedicinenewsletter.com

Subscribers pay the same $15 a year subscription rate but have access to more than 165 articles from back issues as well as current issues. You can search the site either by category, or by key words making the Wilderness Medicine Newsletter site a much more useful reference for everything from reviewing splinting to the prevention and treatment of tropical diseases.

Check it out!

Advertisements

Toxins #5 – Fugu Poisoning

December 29, 2006

Pufferfish Poisoning = Fugu:

Even though it is a bit exotic, no blog on fish poisoning would be complete without a discussion of Takifugu, a Japanese delicacy.

This is a more of an intentional than accidental poisoning, in that someone purposely ate a fish that they knew was toxic and could potentially kill them. 

But, they ate it anyway.

In the wilderness setting, someone would have to catch a pufferfish and then decide to eat it. 

In the process they could get fugu poisoning.

Fugu, or to be exact, Takifugu, is a pufferfish that is commonly found in oceans between the latitudes of 45N and 45S. 

When approached by a predator, if inflates itself to 2 -4 times its normal size. 

As a further defense, it also contains a deadly poison – Tetrodotoxin in its internal organs, sex organs, and skin. 

In order to serve this “delicacy,” you have to be a specially trained and licensed fugu chef. 

Tetrodotoxin:

Tetrodotoxin or anhydrotetrodotoxin 4-epitetrodotoxin, is a neurotoxin that is 1200 times deadlier than cyanide.
 
It causes paralysis of the muscles but leaves the victim fully conscious as they die of asphyxiation.
 
The pufferfish does not produce the toxin but instead harbors a Pseudomonas bacteria in its tissues that elaborates the tetrodotoxin.

Symptoms of Fugu poisoning:

History – they have recently been eating pufferfish
Onset is rapid – minutes
Muscular paralysis
Dyspnea and respiratory failure

Treatment of Fugu poisoning:

Support respiratory and circulatory systems until the effects of the tetrodotoxin
wears off.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Toxins #4 – Shellfish Poisoning

December 27, 2006

Shellfish Poisoning

A local guy showed us how to harvest fresh oysters and clams.  For dinner we ate a big old bucket of fresh-from-the-sea raw oysters, and a pile of steamed clams for dinner. What a treat.  But, within a few hours, we all developed nausea and a sort of drunken feeling – a little hard to walk straight and a kind of floating sensation.  I wouldn’t want to take a sobriety test right now. 

Shellfish Poisoning:

There are three forms of shellfish poisoning, Paralytic, Neurotoxic, and Amnesic.

All caused by the consumption of filter feeders that have fed upon dinoflagellets containing different types of saxitoxins.

These poisonings usually occur with a bloom of the algae such as Red Tide – when the water temperatures and nutrients are favorable for rapid multiplication of the algae, and their numbers increase to the point where they color the water red or brown. 

When this occurs, areas of shellfish harvesting should be closed to prevent the consumption of the filter feeders. 

Like ciguatoxin, these saxitoxins are also heat-stable, so cooking will not eliminate the
biotoxins.

History is important in the diagnosis, in that they have recently eaten filter feeders; mussels, clams, oysters, scallops, cockles, crabs, or lobsters. 

As these filter feeders feed upon the dinoflagellets and diatoms, they concentrate the various types of saxitoxins in their gut tissues. 

Unfortunately, these tissues are usually consumed with the rest of the filter feeder. 

The exception is the scallop. If the adductor muscle is the only portion of the scallop that is eaten, it is safe because it does not contain the saxitoxins.

These three forms of shellfish poisoning; Paralytic, Neurotoxic, and Amnesic, are caused by three different types of saxitoxin, each from a different type of dinoflagellet or diatom that was consumed by the filter feeder.

Paralytic Shellfish Poisoning:

Symptoms: 

Onset is 2 – 24 hours.
Paresthesias of the face, arm, legs
Headache
Dizziness
Nausea
Muscular incoordination
“Floating sensation”

Severe Symptoms:

Muscle paralysis
Respiratory failure
Death is rare, but it can occur due to respiratory failure in 2 – 24 hours.
 
Neurotoxic Shellfish Poisoning:

Symptoms:

Onset in 1 – 3 hours.
Paresthesias of the mouth, arms, and legs
Incoordination
Gastrointestinal upset: nausea, vomiting, diarrhea
Can have temperature reversal

Amnesic Shellfish Poisoning:

Biotoxin is from a diatom – Nitzchia pungens

Symptoms: 

Onset in 2 – 24 hours
GI distress: nausea, vomiting, diarrhea
Dizziness
Headache
Disorientation
Permanent short-term memory loss – yes PERMANENT

Severe Symptoms:

Seizures
Weakness progressing to paralysis
Death

Treatment of all forms of shellfish poisoning:

Supportive care; rest, liquids, and treat the symptoms.
There are no antitoxins available.
Spontaneous recovery in 2 days to months. 
The short-term memory loss can be permanent.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

 

Toxins #3 – Scromboid Poisoning

December 25, 2006

Scromboid Poisoning:

We went to a local restaurant on the beach last night, known for their fresh mackerel caught that day.  It was delicious.  But, several hours later we all had nausea, vomiting, diarrhea, a red rash, sweating, and a strong metallic taste in our mouths.  We must have had too much of the cheap local beer. 

Scromboid:
 
Scromboid poisoning occurs when tuna, mackerel, or bonito are caught, but not properly refrigerated before cooking and eating. 

If the fish is not kept alive or refrigerated bacterial spoilage of the fish will occur. 

The bacteria will multiply in the fish flesh and convert the histidines, naturally occurring chemicals in the flesh of the fish, to histamines. 

When the fish is later eaten, the individual will essentially get an overdose of histamines. 

Like the biotoxins, the histamines are heat-stable, so cooking does not offer protection.

Symptoms:

Onset occurs in 2 minutes to 2 hours
Rash
Flushing
Diarrhea
Vomiting
Abdominal pain
Sweating
Headache
Burning or swelling of the mouth
Metallic taste

Treatment:

Antihistamines.
May need epinephrine, i.e. treat like anaphylaxis.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Toxins #2 – Fish Biotoxins

December 21, 2006

Ciguatera Poisoning:

Can occur when various marine finfish (barracuda, red snapper, grouper, amberjack, sea bass, triggerfish, or other reef fish) are consumed. 

Because they are high up on the food chain, they can accumulate a great deal of the biotoxins in their digestive organs.

The risk is in eating any large fish from tropical and subtropical waters of the West Indies, Caribbean, Pacific, and Indian Oceans between the latitudes of 35N to 35S.

In these waters the filter feeders have been consuming small dinoflagellets (algae), in particular, Gambierdiscus toxicus, and these algae contain ciguatoxin (CTx-1).  As the ciguatoxin progresses up the food chain, it becomes concentrated in the intestinal tracts of the fish. 

If they have not been cleaned properly, eliminating the contents of the bowel, consuming them can be toxic due to ciguatoxin.

Signs & Symptoms of Ciguatera Poisoning:

Ciguatera can cause gastrointestinal, neurological, or cardiovascular symptoms.

History – the patient has recently eaten fish, from a species of marine finfish.

Onset of symptoms is typically in about 6 hours but can occur in 10 minutes – 24 hours after eating the fish.

Symptoms:

Gastrointestinal – usually mild:

Nausea

Vomiting

Diarrhea

Numbness & tingling about the mouth and extremities (paresthesias)

Neurological – can be severe:

Paresthesias

Muscle pain – myalgia, arthralgia

Dizziness & vertigo

Headache

Sensation of temperature reversal: hot feels cold and cold feels hot

Cardiovascular – can be severe:

Dysrythmia – Arrhythmia

Bradycardia

Tachycardia

Decreased BP (hypotension)

Treatment:

Is strictly supportive care: rest, liquids, and treat the symptoms.

There is no antitoxin.

It may take days to weeks to recover.  

Deaths are rare; they are secondary to respiratory and cardiovascular failure.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

Toxins #1 – The Manchineel Tree

December 18, 2006


This week we find ourselves in the Caribbean so it seems fitting to write a few informative blogs about medical emergencies, specifically potential poisons that are peculiar to this part of the world. 

Manchineel Tree Poisoning: The Death Apple 

Recorded on the internet is an account of what happened to two curious gentlemen while staying on a Caribbean island:  Strolling along a beautiful, deserted beach in the Caribbean, they found some fruit that looked like small green apples under a large tree overhanging the beach. After one of the gentlemen took a bite of an apple and found it to be quite sweet and tasty, his friend and he both then each ate one and found them very satisfying.  After 10 minutes or so, they noticed an unusual burning sensation in their mouths that evolved into swelling and tightness of the throat and difficulty swallowing.  Alcohol seemed  to make the symptoms worse.      

poisonous tree 

Manchineel Tree: 

One particular toxic plant worth mentioning is the manchineel tree, Hippomane mancinella, also known as the beach apple or death apple.  This tree grows on the shores of islands and coastlines of the Caribbean Sea.  A large deciduous tree that has a small green apple-like fruit, it is considered to be one of the most poisonous plants on earth.  Given this distinction, it is a tree worth being able to recognize when traveling in this part of the world.  Do not sit under it, even during a rain storm, as the droplets of water falling off it contain enough toxic latex to cause a severe contact dermatitis.  For the same reason do not touch the leaves, the bark, or burn the wood.  The apple-like fruit of the tree contains a potentially deadly poison.  The two adventurers mentioned in the preceding paragraph might well have expired from their experimental taste-test.

This  tree contains tigliane phorbol esters.  Skin contact can cause blistering, burns, erythema, swelling, and inflammation.  If ingested, it will cause burning and swelling of the oral mucosa, esophageal ulcerations, edema, and cervical lymphadenopathy, making it impossible to swallow, difficult to talk, and hard to breathe.

 

Treatment consists of cleansing the skin with soap and water to remove the plant latex, being careful to avoid further exposure and using  antihistamines to minimize the immune response and the edema.

There is more information about this and other ocean-related toxins in a recent Wilderness Medicine Newsletter, entitled Poisonous Pearls.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.