雪卡毒素中毒13例剖析

目的:探讨雪卡毒素中毒的原因、临床表现、治疗和预防。方法:分析13例中毒病人的临床资料并综合文献资料进行分析。结果:病人进食有毒海鱼肉后1.5～7h,表现以急性胃肠炎为主的消化系统症状及以温度感觉倒错为主的神经系统症状。经过解痉、止痛、补充血容量,纠正失水、补充电解质等对症处理,均治愈出院。结论:雪卡毒素多存在于部分深海鱼的体内,中毒后出现消化、神经、心血管系统症状,以温度感觉倒错具有特征性。病程1～5周,预后良好,短期内可复发。     

雪卡毒素集体中毒的急救护理

目的探讨雪卡毒素集体中毒的护理和预防方法。方法根据雪卡毒素的临床表现，重点观察消化、神经、心血管系统症状，对症施以护理。结果44例雪卡毒素中毒的患者治疗3～14d后，均全愈出院，无严重并发症发生。结论做好市民的宣教对阻止和预防雪卡毒素中毒起关键作用。     

雪卡毒素集体中毒的急救护理

目的探讨雪卡毒素集体中毒的护理和预防方法.方法根据雪卡毒素的临床表现,重点观察消化、神经、心血管系统症状,对症施以护理.结果44例雪卡毒素中毒的患者治疗3～14 d后,均全愈出院,无严重并发症发生.结论做好市民的宣教对阻止和预防雪卡毒素中毒起关键作用.     

雪卡毒素中毒２５例分析

目的：探讨雪卡霉素中毒的原因,临床表现、治疗和预防。方法：分析２５例中毒患的临床资料并结合献资料。结果：雪卡毒素广泛存在热带、亚热带深海鱼中,其中石斑鱼、鲈鱼最常见,是鱼类通过食物链获得,中毒后经２－１０h潜伏期,出现以急性胃肠炎为主的消化道症状和心血管症状,２－３d后伴有特征性、较持久的温度感觉倒错。结论：中毒后以温度感觉倒错为特征,预后良好,病程２－３wk,为避免中毒,建议勿食用重１.5kg以上的深海鱼,特别是鱼头和内脏。     

41例雪卡毒素中毒病人的临床救治及护理

目的分析雪卡毒素中毒病人的临床特点,总结病人救治及护理对策。方法对41例雪卡毒素中毒病人的临床资料作回顾性分析及参阅有关文献,了解其临床特点,评价救治及护理效果。结果全部病例均有急性胃肠炎为主的消化道症状,部分病人出现以心率和血压变化为主的心血管症状和以皮肤蚁爬感、瘙痒、痛温觉倒错为主的神经系统症状;经对症支持治疗,配合恰当的护理,全部病人2～3周内症状消失,无1例死亡。结论雪卡毒素中毒早期出现急性消化道症状应与急性胃肠炎鉴别诊断,对症支持治疗,严密观察病情变化,尤其要注意心率、血压的变化,加强生活护理和皮肤护理,同时做好心理护理及饮食健康宣教是救治雪卡毒素中毒病人的有效措施。     

雪卡毒素中毒患者的心血管系统临床表现

目的:探讨雪卡毒素(ciguatoxin)中毒患者的心血管系统临床表现特点.方法:对86例雪卡毒素中毒伴有心血管系统临床表现患者的临床资料进行数理分析.结果:伴心血管系统临床表现的雪卡毒素中毒患者占24%(86/358).病人进食含雪卡毒素的鱼或鱼汤后约3～16 h出现心血管系统的症状,主要表现为心悸、胸闷等,部分病人的血压、心率上升,部分病人则下降;心肌酶谱未出现明显异常;86例均出现心电图异常,79例(92%)表现为窦性心动过缓、窦性心动过速、室上性期前收缩、室性期前收缩,7例(8%)表现为Ⅰ度房室传导阻滞及Ⅱ度Ⅰ型房室传导阻滞,未见明确的ST-T改变;心脏超声检查均未见明显异常.病程1～2周,预后良好.结论:雪卡毒素只是损害心脏的传导系统,而对心肌本身无明显的损害.     

暴发性雪卡毒素中毒59例

目的探讨雪卡毒素中毒的临床特征。方法对一起进食“老虎斑”致59人雪卡毒素中毒事件进行临床回顾性描述,并结合文献进行分析。结果雪卡毒素广泛存在热带、亚热带珊瑚礁鱼中,其中石斑鱼最常见,是鱼类通过食物链获得。中毒人群男性占76·27%,30~49岁占50·85%,中毒后0·5~16h出现症状,有头晕、乏力、腹痛腹泻(93·22%),恶心呕吐(84·74%),心悸胸闷(49·15%),低血压(<90/60mmHg,44·07%,心率减慢(<60次/min,49·15%);2~3d感觉异常(62·71%),持续2~5周;其中温度感觉倒错(55·93%),持续2~3周。饮酒者出现低血压、心率减慢、感觉异常比无饮酒者更明显(P<0·01)。结论雪卡毒素中毒可造成胃肠功能紊乱、心血管功能障碍、持续长时间的神经感觉异常,并且以温度感觉倒错最具特征性;饮酒可加重病情,预后良好。为避免中毒,建议勿食用重1·5kg以上的珊瑚礁鱼,特别是其头和内脏。     

急性雪卡毒素中毒的神经电生理特点

目的 探索急性雪卡毒素中毒早期周围神经的运动感觉传导速度变化特点。方法 对51例急性雪卡毒素中毒患者有四肢及身体其他部位感觉异常的病人进行正中神经及胫神经的感觉、运动传导速度检查，其中9例进行了三叉神建的感觉传导速度及瞬目反射及神觉诱发电位检查。结果 正中神经的感觉传导速度异常率为31．4％，胫神经为54.9％。下肢多于上肢（P〈0.001）。运动神经传导速度及三叉神经感觉传导速度、瞬目反射及视觉诱发电位未发现异常。结论 急性轻度雪卡毒素中毒以四肢远端感觉障碍为主，下肢多于上肢，早期可出现感觉传导速度改变。     

15例雪卡毒素中毒的护理

目的总结雪卡毒素中毒的护理及预防要点。方法对本院收治的15例雪卡毒素中毒患者进行救治护理及预防中毒的指导。结果15例患者均痊愈出院,平均住院时间为5.3d;随访1个月,所有患者均无不适反应。结论迅速诊断、有效地治疗,针对雪卡毒素中毒出现的消化系统、神经系统、心血管系统损害做好护理,加强健康教育及心理护理对患者康复至关重要。     

1例氯胺酮中毒性神经肌肉病的护理

氯胺酮,民间又称为K粉,是一种分离性麻醉药,20世纪70年代初用于临床,90年代后期在全球范围被广为滥用,很容易过量中毒甚至发生致命危险,此神经肌肉病为首发症状的氯胺酮中毒就诊于神经内科患者较少见,现将我科收治的1例氯胺酮中毒神经肌肉病报道如下。1病例介绍1.1病史患者,男性,40岁,城管工人,自2006年6月吸K粉在迪吧蹦迪,出现双下肢乏力感觉麻木,以膝关节为甚,未做任何治疗,2、3d后自觉症状缓解,其后,患者多次吸K粉,每次都出现双下肢乏力麻木,约1周后症状自动缓解,于2007年1月,患者吸K粉,蹦迪后,再次出现双下肢乏力、麻木,上楼梯费力,解…     

Ciguatera fish poisoning

Ciguatera fish poisoning following consumption of a variety of fishes presents a distinct complex of polymorphous symptoms, including gastrointestinal (abdominal pain, diarrhea, vomiting, nausea), neurological (primarily parasthesia, dysesthesia), and cardiovascular (bradycardia, hypotension, tachycardia). The fishes involved include herbivores (surgeonfish) and carnivores (e.g., snapper, grouper, barracuda, jack, amberjack). Clinical symptoms seem to differ according to whether toxicity is caused by herbivores or carnivores, that is, there seem to be differences between the gastrointestinal and neurological symptoms associated with herbivores, and the gastrointestinal, neurological, and cardiovascular symptoms following consumption of carnivores. The final structure of ciguatoxin (CTX) from a carnivore species (moray eel livers) has been recognized as a lipid polyether closely related to other polyethers from dinoflagellates (okadaic acid, brevetoxin, maitotoxin, scaritoxin), to sponges (okadaic acid and norhalichondrin A), and to the streptomyces (antibiotics, monocarboxylic polyethers). Pharmacological studies suggest that, like the antibiotic polyether ionophores, ciguatoxin (Na +) and its related polyethers likewise affect cell membrane and electrolyte imbalances. Screening of toxin fishes for ciguatoxin and related polyethers may soon be a reality employing monoclonal antibodies in the stick enzyme immunoassay. Research in human diagnostic tests and treatment of afflicted individuals is presently limited for ciguatera poisoning.     

A Curious Case of Ciguatera Fish Poisoning in the Midwest and a Review for Clinicians

BackgroundCiguatera poisoning is one of the most prevalent types of fish poisoning, but it is often underreported, leading many health practitioners to be unfamiliar in correctly identifying and treating this toxicity.Case ReportWe present a case of ciguatera toxicity encountered in an emergency department in a Midwest community hospital setting. A 56-year-old woman presented to the ED with symptoms of perioral numbness, generalized pruritis, and hot/cold temperature reversal. Through careful history taking it was determined that the patient had recently returned from vacationing in the Caribbean and had been consuming meals containing various types of fish. A clinical diagnosis of ciguatera toxicity was made, and the patient was treated supportively.Why Should an Emergency Physician be Aware of This?This topic is important in the realm of emergency medicine because it presents a known toxicologic pathogen in an unsuspecting geographic location. This case highlights the importance of maintaining broad differentials and considering a patient's travel and exposure history to make the clinical diagnosis of ciguatoxin as well as the importance of preventative management to avoid recurrence of symptoms. We review the etiology of this fascinating toxin as well as the clinical implications in the diagnosis and management of this toxicity.     

Evaluation of the Hawaiian reef fishes with the solid phase immunobead assay

This study presents data on the evaluation of a laboratory ciguatera kit based on the solid phase immunobead assay (SPIA) for the detection of ciguatoxin in Hawaiian reef fish. The SPIA was performed on fish catches by volunteer fishermen throughout the State of Hawaii. A total of 1,067 fish of various species were tested for ciguatoxin (CTX) using the SPIA kit. Of the total 1,067 fish tested, 510 were from Oahu, 402 from Hawaii, and 75 from Maui. The number of fish from Molokai, Kauai, and Lanai were 23, 20, and 7 respectively. Twenty percent of the total fish tested were positive, 41% borderline, and 39% negative for ciguatoxin. The highest percentage of SPIA-positive fish were from Hawaii (27%) followed by Oahu (19%) and Kauai (15%). These results correlate with the reported incidents from the Department of Health (DOH) of actual ciguatera poisoning in the State of Hawaii. Fish in all three categories of the SPIA test values were eaten. No false negatives were noted with individuals eating SPIA negative fish. Of the 232 SPIA borderline values eaten, 3 species of fish caused ciguatera poisoning. These fish included 2 papio, 1 mullet, and 1 po'ou. Of the 17 SPIA positive fish eaten, 5 caused ciguatera poisoning: 2 papio, a kole, an uhu, and a weke. The SPIA ciguatera test did protect the public when only SPIA-negative fish were eaten. The borderline and positive SPIA fish were generally unsafe, especially the positive fish. The data indicated that the probability of getting ciguatera with a SPIA positive fish was 1 out of 3. The Caranx sp. (papio, ulua) appeared to be one of the major culprits in ciguatera poisoning in Hawaii. This was compatible with the known yearly reports from the DOH. © 1993 Wiley-Liss, Inc.     

Shellfish and fish poisoning related to the toxic dinoflagellates

At least four different species of the toxic dinoflagellates cause shellfish and fish poisoning in the United States: Ptychodiscus brevis, neurotoxic shellfish poisoning; Protogonyaulax catenella and P tamarensis, paralytic shellfish poisoning; and Gambierdiscus toxicus, ciguatera fish poisoning. These three disorders have similar clinical manifestations, primarily neurologic and alimentary. A complete history is essential; confirmation, while dependent on specific laboratory analysis, is usually based on a history of ingestion of fish or shellfish previously associated with these types of poisonings. The principal toxins affect sodium channels; Ptychodiscus brevis toxins and ciguatoxin by stimulating these channels and saxitoxin by blocking them. Since no antidote is known, treatment is symptomatic. Public health measures and public education are necessary to prevent this form of poisoning.     

Phencyclidine An Emerging Drug Problem

Abstract

A case of a severe episode of ciguatera poisoning in a mother during the second trimester is presented. The mother experienced an increase of fetal movements one hour after the poisonous meal. She endured multisystemic symptoms typical of ciguatera for eight weeks. The presence of ciguatoxin in the fish was confirmed by immunoassay and two bioassays. The newborn at term was normal with adequate respiratory and neurological reflexes. The child developed normally in his first 10 months. This is in contrast with another report of a mother exposed to ciguatoxin at term who delivered an infant suffering from facial palsy and possible myotonia of the hands. Dose and gestational timing may explain these observed differences.     

6例儿童急性鱼胆中毒临床分析

目的：分析总结儿童鱼胆中毒的原因、临床特征、救治方法和治疗效果,探讨儿童鱼胆中毒造成多器官功能损害的机制和有效治疗手段。方法：回顾分析6例儿童鱼胆中毒的原因,致病物质的毒性,患者的临床表现、实验室检查资料及治疗方法和治疗效果等。结果：6例（100%）鱼胆中毒患儿出现胃肠道症状,5例（83.3%）出现急性肾功能衰竭,5例（83.3%）出现中毒性肝炎,4例（66.6%）出现心肌受损,4例（66.6%）有神经系统表现。经过血液透析（HD）或持续静脉-静脉血液滤过（CVVH）,结合其他综合治疗措施后,5例治愈,1例死亡。结论：儿童鱼胆中毒可导致多器官功能衰竭,尽早血液滤过可提高儿童鱼胆中毒的治疗效果与生存率。     

急性亚硝酸盐中毒38例临床分析

目的:总结急性亚硝酸盐中毒的临床特点和防治方法.方法:回顾性分析2008年1月至2010年12月我科急救的急性亚硝酸盐中毒38例患者的临床资料.结果:38例急性亚硝酸盐中毒患者均在12 h内症状缓解,1～5天痊愈出院,平均住院时间(2.5±1.5)天,无死亡病例.结论:急性亚硝酸盐中毒应以预防为主,及时诊断和亚甲蓝治疗急性亚硝酸盐中毒的预后良好.     

Ciguatera toxicity

Ciguatera poisoning is the most common foodborne illness caused by a chemical toxin in the United States and is endemic in the Caribbean and Indo-Pacific. Ciguatoxin, produced by a marine dinoflagellate that attaches to algae, is passed up the food chain to large fish and, finally, to humans. The toxin has anticholinesterase activity. The clinical picture is characterized by a variety of gastrointestinal, neurologic and cardiovascular symptoms, usually self-limited. Amitriptyline is reported to be beneficial.     

Simplified solid-phase immunobead assay for detection of ciguatoxin and related polyethers

This study examined the development of a highly simplified solid-phase colored latex immunobead assay for the detection of ciguatoxin and related polyethers. This procedure was compared with the stick enzyme immunoassay previously reported. Chi-square analysis of two separate experiments on 153 and 283 fish of various species gave chi 2 values of p less than 0.001 and p less than 0.005, respectively. Agreement between the two procedures with 26 fish implicated in ciguatera poisoning was 100%. A preliminary assessment in the field showed encouraging results. The procedure appears to be simple and applicable to field use. Furthermore, this procedure should be applicable to other antibody-antigen detections, especially low dalton determinations.