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Question: Tox

A 16yo boy just returned from a vacation to the U.S. Virgin Islands. On the flight, he developed abdominal pain, nausea, vomiting, which he initially attributed to airsickness. He came straight from the airport to the ED, and now he also complains of lingual and circumoral paresthesias, painful paresthesias of his hands and feet, feeling as though his teeth feel “loose”, and generalized weakness. Another classic symptom of this entity is:

A. Urticaria and flushing

B. Tachycardia

C. Profuse watery diarrhea

D. Paralysis

E. Temperature reversal

Also, if you’re interested in the Peds ID Antibiotics Question of the Week, you can find it here


pemsou5_wp • June 27, 2017

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  1. Kelly July 3, 2017 - 8:04 pm Reply

    E. Temperature reversal
    This patient is presenting with ciguatera toxicity, the most common form of non-bacterial food poisoning from fish worldwide. It is associated with the consumption of reef fish, particularly grouper, amberjack, red snapper, eel, sea bass, barracuda, Spanish mackerel. It is common in Hawaii, Florida, Caribbean, Australia, and South Pacific islands. In the US Virgin Islands, there are 300 cases per 10,000 population annually. Symptoms are due to consumption of ciguatoxin in the flesh of affected fish. Toxin precursors are produced in dinoflagellates (algae) consumed by the fish; precursors become toxin during metabolism in the fish and accumulate. The toxin has no odor, color, or taste. Besides the boy’s described symptoms, bradycardia, hypotension & shock may occur, pruritis is common, and worse neuro symptoms including ataxia, respiratory arrest, and coma rarely occur. A classic symptom is temperature reversal (cold things feel hot and vice versa). Symptoms onset 6-12 hrs on average, up to 24 hrs or more, after eating fish, and can last a week. Diagnosis is clinical, treatment is supportive. Activated charcoal may help if within 3-4 hrs of ingestion.

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