Patient is a 25-year-old male without medical history brought to the emergency department with severe, diarrhea and vomiting three hours after eating dinner at a local fish restaurant. Associated symptoms include watery eyes, myalgias, arthralgias and numbness of the tongue, lips and throat. The patient states that his dish consisted of red snapper that was well-done and had no unusual smell or taste. 1. What is the most likely cause of the symptoms? 2. What types of interventions or treatment are indicated? 3. What is the mechanism of action of this toxin? 4. What, if any, food preparation strategies can help prevent transmission of toxin to humans? 5. What type of counseling should these patients be given?
- Ciguatera poisoning is the most likely cause of the symptoms, which include severe diarrhea and vomiting, along with numbness of the tongue, lips, and throat, as well as myalgias and arthralgias.
- Treatment for ciguatera poisoning is mainly supportive care, including rehydration with fluids, antiemetic and antidiarrheal medications, pain management, and hospitalization for severe cases.
- Ciguatoxins act by opening voltage-gated sodium channels in nerve cells, leading to increased permeability and altered neuronal function, which can cause gastrointestinal, neurological, and cardiovascular effects.
- Avoiding consumption of large predatory reef fish, especially from areas known to have high levels of ciguatoxins, can help reduce the risk of exposure. Eating fish liver and limiting consumption of other high-risk fish, such as moray eel and amberjack, is also recommended.
- Patients should be advised to avoid consumption of certain types of reef fish, seek medical attention if symptoms develop, stay hydrated, and manage symptoms with over-the-counter medications. Patients should also be informed of the potential long-term effects of ciguatera poisoning, such as sensory disturbances and fatigue. Medical History Essay Paper