Marine toxins (saxitoxin, tetrodotoxin, conotoxin)

Saxitoxin, tetrodotoxin, and conotoxin can cause transient paralysis, which is especially concerning with regard to respiratory muscles.[25]Hoffman RS, Howland MA, Lewin NA, et al. Goldfrank’s toxicologic emergencies. 10th ed. New York: McGraw-Hill Education; 2015.

Assessment of acute motor deficit

Toxin-induced paralysis can lead to respiratory failure and arrest, which can lead to death. Difficulty speaking, breathing, or swallowing, or vital sign abnormalities should prompt consideration of mechanical ventilation. This generally occurs during the acute intoxication period (i.e., first 24-48 hours), and can lead to respiratory and cardiac arrest.[3]Alberta Health, Government of Alberta. Public health disease management guidelines: shellfish poisoning. Oct 2021 [internet publication]. https://open.alberta.ca/publications/shellfish-poisoning ​[25]Hoffman RS, Howland MA, Lewin NA, et al. Goldfrank’s toxicologic emergencies. 10th ed. New York: McGraw-Hill Education; 2015.[29]Islam QT, Razzak MA, Islam MA, et al. Puffer fish poisoning in Bangladesh: clinical and toxicological results from large outbreaks in 2008. Trans R Soc Trop Med Hyg. 2011 Feb;105(2):74-80. http://www.ncbi.nlm.nih.gov/pubmed/21129761?tool=bestpractice.com ​​

Acute respiratory failure

Tetrodotoxin can lead to hypotension and, as a result, end-organ damage. Conotoxin has the potential to lead to cardiovascular collapse and, as a result, end-organ damage.[25]Hoffman RS, Howland MA, Lewin NA, et al. Goldfrank’s toxicologic emergencies. 10th ed. New York: McGraw-Hill Education; 2015.Treatment in these cases is supportive care.

Cone snail stings and blue-ringed octopus bites can be complicated by local wound infection. Treatment includes local wound care and antibiotics if indicated. Tetanus prophylaxis is also indicated.[25]Hoffman RS, Howland MA, Lewin NA, et al. Goldfrank’s toxicologic emergencies. 10th ed. New York: McGraw-Hill Education; 2015.[40]Havers FP, Moro PL, Hunter P, et al. Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis caccines: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83. https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm http://www.ncbi.nlm.nih.gov/pubmed/31971933?tool=bestpractice.com

Nausea, vomiting, and diarrhoea as a result of gastrointestinal illness may lead to dehydration, which should be treated with supportive therapy.

Volume depletion in adults

While necessary in many patients that undergo marine toxin poisoning, supportive care adjuncts themselves pose many risks. Physicians should consider the risks and side effects of intubation, sedation, pressor or other cardiovascular support, and resuscitation.