Investigations
1st investigations to order
clinical diagnosis
Test
Based on the clinical signs and symptoms, and a history of seafood or shellfish consumption, or a history of shell collection, swimming or wading in the sea, diving, or aquarium maintenance.
Result
features of marine toxin poisoning
Investigations to consider
pulse oximetry
Test
Should be performed in all patients to evaluate severity of poisoning, and while patient being monitored for progression of weakness and paralysis.[29]
Result
may be normal or show hypoxaemia
capnography
Test
Should be performed in all patients to evaluate severity of poisoning, and while patient being monitored for progression of weakness and paralysis.[29]
Result
may be normal or show respiratory compromise
serial pulmonary function tests
Test
Should be performed in all patients to evaluate severity of poisoning, and while patient being monitored for progression of weakness and paralysis.[13][29] Serial measurements including FVC and/or negative inspiratory force are taken. Do not wait for abnormal arterial blood gases as it occurs late in the course after clinical decompensation.
Result
may be normal or show respiratory compromise
arterial blood gases
Test
Should be performed in patients with potential need for airway control and ventilation.[29]
Result
may be normal or show acidosis, hypercarbia, or hypoxia
chest x-ray
Test
Should be performed in patients with loss of airway control and concern for pulmonary aspiration.
Result
may be normal or show signs of aspiration syndrome
CT brain
Test
Should be performed in patients with unclear presentation and possible intracranial event.
Result
may be normal; may show hypoxic brain injury
serum electrolytes
Test
Should be performed in patients with significant gastrointestinal complaints and possible dehydration.
Result
may be normal or show acidosis, renal dysfunction, or electrolyte abnormalities
high-performance liquid chromatography in flesh of seafood
Test
Standard method of confirmation by investigating authorities.[28] These studies often take days or weeks to accomplish, making clinical recognition and supportive management key to the initial management of cases of marine toxin exposures.
Result
positive for saxitoxin, tetrodotoxin, or conotoxin
Emerging tests
serum/urine toxin analysis
Test
Emerging as potential test for toxin exposure.
Result
positive for saxitoxin, tetrodotoxin, or conotoxin
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