Department of Medicine, Chon Buri Hospital,
J Med Assoc Thai 2001 Mar;84(3):385-9
1989 and 1999, 25 cases of puffer fish poisoning (PFP) were admitted to the
medical service of Chon Buri Hospital. The severity of the poisoning was classified
into four stages based on clinical signs and symptoms of PFP. Of the 25 patients,
23 were males and 2 were females. Three patients were in stage 1, four were
in stage 2 and eighteen were in stage 4. Paresthesia was the early presenting
complaint of all patients. Paresthesia consisting of either numbness or tingling
of lips, tongue, around the mouth, hands, and feet. Muscle weakness, dizziness,
vertigo, nausea and vomiting were common complaints. Eighteen patients developed
acute flaccid paralysis and respiratory failure requiring ventilatory support.
All patients received symptomatic and supportive treatment and general supportive
care, including gastric lavage and intravenous fluid. Intubation and mechanical
ventilation was considered especially when paralysis was progressing rapidly.
Most were taken off the respirator 12-48 hours later. All patients completely
recovered without any sequelae. Clinical features of PFP, toxicity of puffer
fish and management were discussed.