Management of puffer fish poisoning.

TLDR: The roles of anticholinesterases and cysteine in the management of puffer fish poisoning remain uncertain and more clinical studies are required to confirm their therapeutic efficacy.

Abstract: Sir,—I was interested in the recent review article on animal toxins by Karalliedde [1]. In Hong Kong puffer fish poisoning occurs sporadically. The most important management is early intubation and assisted ventilation for cases with respiratory failure and circulatory support, with fluid and inotropes for hypotensive patients. Although there is no specific antidote for the tetrodotoxin, certain measures may also be useful in the treatment of such poisoning. Removal of unabsorbed toxin by gastric lavage with 2 % sodium bicarbonate is useful as tetrodotoxin is less stable in an alkaline solution [2]. Anticholinesterase drugs such as edrophonium and neostigmine, especially if given early in these poisoning, have been effective in reversing the muscle weakness and hastening spontaneous recovery [3–7]. Cysteine, by opening sodium channels, has been used to antagonize the blocking effect of tetrodotoxin on nerve conduction [2, 8]. However, the roles of anticholinesterases and cysteine in the management of puffer fish poisoning remain uncertain [9, 10] and more clinical studies are required to confirm their therapeutic efficacy.