Scombroid Toxicity Treatment & Management

  • Author: John D Patrick, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 4, 2012
 

Prehospital Care

  • Prehospital care is primarily supportive.
  • Provide oxygen and monitor cardiac function as needed.
  • Antihistamines and bronchodilators may be used as needed if advanced life support personnel are involved.
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Emergency Department Care

If the patient only has minimal symptoms of scombroid toxicity, reassurance and observation may be the only treatment necessary.

  • If clinically necessary, obtain an ECG and institute intravenous access, oxygen, and cardiac monitoring.
  • Serum histamine levels and urinary histamine excretion are elevated in persons with acute illness; however, they are usually not available in a timely manner and do not have practical value for acute treatment of scombroid toxicity.
  • Treat with antihistamines as needed; H1- and H2-blockers may be useful.
  • Consider use of activated charcoal only if the presentation is very early and a large amount of fish was ingested.
  • Although bronchospasm is rare, use standard treatment if it occurs.
    • Inhaled beta2-adrenergic agonists
    • Inhaled ipratropium bromide (may be particularly useful for the treatment of histamine-induced bronchospasm)
    • Epinephrine
  • Extremely rare reported cases of myocardial dysfunction, ischemia, or infarction related to scombroid poisoning exist; standard treatment for these complications, including pressors, should be used. One reported case documents successful treatment of a 36-year-old woman with severe myocardial dysfunction refractory to pressor support by using a biventricular assist device for 8 days.[9]
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Consultations

Consult the regional poison control center or a local medical toxicologist (certified through the American Board of Medical Toxicology or the American Board of Emergency Medicine) for additional information and patient care recommendations.

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Contributor Information and Disclosures
Author

John D Patrick, MD  Assistant Professor of Medicine, Division of Emergency Medicine, Harvard Medical School; Staff, Walk-In Center, Mount Auburn Hospital

John D Patrick, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Norris, MD  Professor, Department of Surgery, Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and 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.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Director of Medical Toxicology, Allegheny General Hospital

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

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An example of a typical scombroid rash, in this case from tuna. Image courtesy of Amanda Oakley, MBChB, FRACP.
An example of a typical scombroid rash, in this case from tuna. Posterior view of the same patient as in the image above. Image courtesy of Amanda Oakley, MBChB, FRACP.
 
 
 
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