Ciguatera Toxicity in Emergency Medicine Medication

  • Author: Thomas C Arnold, MD, FAAEM, FACMT; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 21, 2010
 

Medication Summary

Medications used to treat ciguatera poisoning include (1) neurologic agents, (2) serotonin-norepinephrine reuptake inhibitors, (3) antihistamines, (4) analgesics, (5) antipyretics, and (6) anti-inflammatories.

One group in Japan has reported developing a strategy to use monoclonal antibodies to treat ciguatera toxicity.[6] Possibly an effective treatment will be available in the near future.

Next

Diuretics, osmotic

Class Summary

These agents are used empirically to treat neurologic symptoms associated with ciguatera poisoning.

View full drug information

Mannitol (Osmitrol, Resectisol)

 

Osmotic diuretic that has become mainstay of acute treatment in recent years.[7] Mechanism of action unknown but has been reported to dramatically diminish or prevent neurologic symptoms associated with ciguatera poisoning. Most effective when given early in course of treatment, but somewhat effective even after several days of symptoms. Neurologic symptoms often decrease within minutes of treatment and may resolve completely within 2 days. At least one prospective, controlled study found no difference between mannitol and normal saline in the treatment of ciguatera poisoning.[8]

Previous
Next

Serotonin/norepinephrine reuptake inhibitors

Class Summary

These agents have central and peripheral anticholinergic effects, as well as sedative effects, and block the active reuptake of norepinephrine and serotonin.

View full drug information

Amitriptyline (Elavil)

 

Reported to relieve pruritus and dysesthesias; may act by blocking fast sodium channels that have been activated by ciguatoxin. Most effective for chronic neurologic symptoms that often follow ciguatera poisoning.

Previous
Next

Analgesics

Class Summary

These agents are used symptomatically to provide pain relief.

View full drug information

Acetaminophen (Tylenol/Panadol)

 

Extremely useful in treatment of headaches.

View full drug information

Indomethacin (Indocin)

 

Relieves myalgias and arthralgias.

Previous
Next

Antihistamines

Class Summary

These agents are used to reduce pruritus (itching).

View full drug information

Cyproheptadine (Periactin)

 

Antihistamine-antiserotonergic agent; reported to ameliorate pruritus.

View full drug information

Diphenhydramine (Benadryl, Benylin)

 

For relief of symptoms caused by release of histamine in pruritus.

View full drug information

Hydroxyzine (Atarax, Vistaril)

 

Antagonizes H1 receptors in periphery. May suppress histamine activity in subcortical region of CNS. Has antipruritic effects.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Thomas C Arnold, MD, FAAEM, FACMT  Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University School of Medicine in Shreveport; Medical Director, Louisiana Poison Control Center

Thomas C Arnold, MD, FAAEM, FACMT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Louisiana State Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Dana A Stearns, MD  Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital

Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Llewellyn LE. Revisiting the association between sea surface temperature and the epidemiology of fish poisoning in the South Pacific: Reassessing the link between ciguatera and climate change. Toxicon. Aug 23 2009;[Medline].

  2. Tsumuraya T, Fujii I, Hirama M. Production of monoclonal antibodies for sandwich immunoassay detection of Pacific ciguatoxins. Toxicon. Jun 11 2009;[Medline].

  3. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. Clin Toxicol (Phila). Dec 2009;47(10):911-1084. [Medline].

  4. Centers for Disease Control and Prevention. Cluster of ciguatera fish poisoning--North Carolina, 2007. MMWR Morb Mortal Wkly Rep. Mar 27 2009;58(11):283-5. [Medline]. [Full Text].

  5. Ting JY, Brown AF. Ciguatera poisoning: a global issue with common management problems. Eur J Emerg Med. Dec 2001;8(4):295-300. [Medline].

  6. Inoue M, Lee N, Tsumuraya T, Fujii I, Hirama M. Use of monoclonal antibodies as an effective strategy for treatment of ciguatera poisoning. Toxicon. Jun 2009;53(7-8):802-5. [Medline].

  7. Friedman MA, Fleming LE, Fernandez M, Bienfang P, Schrank K, Dickey R, et al. Ciguatera fish poisoning: treatment, prevention and management. Mar Drugs. 2008;6(3):456-79. [Medline]. [Full Text].

  8. Schnorf H, Taurarii M, Cundy T. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology. Mar 2002;58(6):873-80. [Medline].

  9. Friedman MA, Arena P, Levin B, Fleming L, Fernandez M, Weisman R, et al. Neuropsychological study of ciguatera fish poisoning: A longitudinal case-control study. Arch Clin Neuropsychol. May 3 2007;22(4):545-553. [Medline].

  10. Bagnis R, Kuberski T, Laugier S. Clinical observations on 3,009 cases of ciguatera (fish poisoning) in the South Pacific. Am J Trop Med Hyg. Nov 1979;28(6):1067-73. [Medline].

  11. Blume C, Rapp M, Rath J, Köller H, Arendt G, Bach D. [Ciguatera poisoning. Growing differential diagnostic significance in the age of foreign tourism]. Med Klin (Munich). Jan 15 1999;94(1):45-9. [Medline].

  12. Blythe DG, De Sylva DP, Fleming LE, Ayyar RA, Baden DG, Shrank K. Clinical experience with i.v. Mannitol in the treatment of ciguatera. Bull Soc Pathol Exot. 1992;85(5 Pt 2):425-6. [Medline].

  13. Butera R, Prockop LD, Buonocore M, Locatelli C, Gandini C, Manzo L. Mild ciguatera poisoning: Case reports with neurophysiological evaluations. Muscle Nerve. Oct 2000;23(10):1598-603. [Medline].

  14. Cameron J, Capra MF. The basis of the paradoxical disturbance of temperature perception in ciguatera poisoning. J Toxicol Clin Toxicol. 1993;31(4):571-9. [Medline].

  15. Dickey RW, Plakas SM. Ciguatera: A public health perspective. Toxicon. Sep 23 2009;[Medline].

  16. Fleming LE, Baden DG, Ayyar RA, Bean JA, Blythe DG, Shrank K, et al. A pilot study of a new ELISA test for ciguatoxin in humans. Bull Soc Pathol Exot. 1992;85(5 Pt 2):508-9. [Medline].

  17. Frenette C, MacLean JD, Gyorkos TW. A large common-source outbreak of ciguatera fish poisoning. J Infect Dis. Nov 1988;158(5):1128-31. [Medline].

  18. Gopalakrishnakone P, Tan CK. Clinical features on 12,890 cases of ciguatera (fish poisoning) French Polynesia. Proceedings: First Asia-Pacific Congress on Animal, Plant and Microbial Toxins. 1987;June 24-27:372-385.

  19. Habermehl GG, Krebs HC, Rasoanaivo P, Ramialiharisoa A. Severe ciguatera poisoning in Madagascar: a case report. Toxicon. Dec 1994;32(12):1539-42. [Medline].

  20. Hamilton B, Whittle N, Shaw G, Eaglesham G, Moore MR, Lewis RJ. Human fatality associated with Pacific ciguatoxin contaminated fish. Toxicon. Jun 16 2009;[Medline].

  21. Inoue M, Miyazaki K, Uehara H, Maruyama M, Hirama M. First- and second-generation total synthesis of ciguatoxin CTX3C. Proc Natl Acad Sci U S A. Aug 17 2004;101(33):12013-8. [Medline].

  22. Lewis RJ. The changing face of ciguatera. Toxicon. Jan 2001;39(1):97-106. [Medline].

  23. Mines D, Stahmer S, Shepherd SM. Poisonings: food, fish, shellfish. Emerg Med Clin North Am. Feb 1997;15(1):157-77. [Medline].

  24. Morris PD, Campbell DS, Freeman JI. Ciguatera fish poisoning: an outbreak associated with fish caught from North Carolina coastal waters. South Med J. Apr 1990;83(4):379-82. [Medline].

  25. Park DL, Gamboa PM, Goldsmith CH. Rapid facile solid-phase immunobead assay for screening ciguatoxic fish in the market place. Bull Soc Pathol Exot. 1992;85(5 Pt 2):504-7. [Medline].

  26. Pearn J. Neurology of ciguatera. J Neurol Neurosurg Psychiatry. Jan 2001;70(1):4-8. [Medline].

  27. Pottier I, Vernoux JP, Lewis RJ. Ciguatera fish poisoning in the Caribbean islands and Western Atlantic. Rev Environ Contam Toxicol. 2001;168:99-141. [Medline].

  28. Schep LJ, Slaughter RJ, Temple WA, Beasley DM. Ciguatera poisoning: an increasing occurrence in New Zealand. N Z Med J. Jan 29 2010;123(1308):100-2. [Medline].

  29. Swift AE, Swift TR. Ciguatera. J Toxicol Clin Toxicol. 1993;31(1):1-29. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.