History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include shellfish or xanthid crab ingestion (saxitoxin); seafood ingestion or handling of blue-ringed octopus (tetrodotoxin); handling of cone snail shells (conotoxin).
oral numbness
Presenting symptom in all case reports of marine toxin exposure.
dysphagia
Presenting symptom in all case reports of marine toxin exposure.
dysarthria (common)
Presenting symptom in all case reports of marine toxin exposure.
nausea (saxitoxin, tetrodotoxin)
Presenting symptom in most case reports of shellfish and puffer fish poisoning.
vomiting (saxitoxin, tetrodotoxin)
Presenting symptom in most case reports of shellfish and puffer fish poisoning.
diarrhoea (saxitoxin, tetrodotoxin)
Presenting symptom in most case reports of shellfish and puffer fish poisoning.
weakness
Presenting symptom in all case reports of marine toxin exposure.
ataxia/incoordination
May be presenting sign of marine toxin exposure.
hypertension (saxitoxin)
Presenting sign in many case reports of shellfish poisoning.
extreme pain (conotoxin)
As a result of cone snail envenomation.
uncommon
hypotension or cardiovascular instability
May be a presenting feature of marine toxin poisoning.
Can be seen in all marine toxin poisonings if severe.
Other diagnostic factors
common
light-headedness/dizziness
May be a symptom in marine toxin exposure.
postural near-syncope/syncope
May be a symptom in marine toxin exposure.
anxiety
May be a symptom in marine toxin exposure.
uncommon
loss of airway-protective reflexes
Evidence of disease progression and need for airway control in cases of severe marine toxin poisoning.
loss of adequate ventilation
Evidence of disease progression and need for ventilation in cases of severe marine toxin poisoning.
hypoxia
Evidence of disease progression and need for oxygenation in cases of severe marine toxin poisoning.
bradycardia
Evidence of disease progression and impending cardiovascular collapse in cases of severe marine toxin poisoning.
apnoea
Evidence of disease progression and need for oxygenation and ventilation in cases of severe marine toxin poisoning.
ventricular dysrhythmias
Evidence of disease progression and impending cardiovascular collapse in cases of severe marine toxin poisoning.
Risk factors
strong
warmer waters
shellfish ingestion (saxitoxin)
Shellfish poisoning, including paralytic shellfish poisoning from saxitoxin, occurs after shellfish consumption from contaminated bays.
xanthid crab ingestion (saxitoxin)
Saxitoxin poisonings can occur after consumption of crab later identified as a xanthid crab with saxitoxin-contaminated flesh.
seafood ingestion (tetrodotoxin)
Tetrodotoxin poisonings occur most often after consumption of fish later identified as puffer fish (Tetraodontidae) with contaminated flesh.
handling of blue-ringed octopus (tetrodotoxin)
Tetrodotoxin poisonings can occur from handling blue-ringed octopus, Hapalochlaena.
handling of cone snail shells (conotoxin)
Conotoxin poisonings occur most often from handling shells of the cone snail, Conus geographus.
exposure to toxins in research/laboratory settings
People who work with marine toxins in a research or laboratory setting should take adequate precautions.[23]
weak
bioterrorism
Saxitoxin, tetrodotoxin, and conotoxin have been highlighted by the US authorities as having the potential to pose a severe threat to public health and safety as possible agents for bioterrorism.[24]
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