eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Shellfish: Follow-up

Author: Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Oct 29, 2009

Follow-up

Deterrence/Prevention

  • Routine surveillance of shellfish beds for known toxins should prevent most forms of shellfish poisoning.
  • Consumption of shellfish harvested outside of regulated areas or during times known to be associated with red tide is dangerous and should be avoided.
  • The feasibility and effectiveness of degrading saxitoxins through chlorination is currently being investigated.6

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to adequately treat dehydration associated with gastroenteritis from shellfish poisoning
  • Failure to recognize subtle respiratory paralysis and provide airway support early in PSP syndromes
  • Failure to recognize shellfish poisoning as a potential etiology of a disease outbreak

Special Concerns

  • Shellfish gastroenteritis caused by viral agents is at epidemic proportions and, for many, has become an unacceptable risk associated with consumption of raw shellfish.
  • Callistin shellfish poisoning has been associated with the Japanese callista clam during spawning months of May to September. It causes a syndrome of cholinergic crisis with muscarinic and nicotinic symptoms.
  • Venerupin shellfish poisoning has been associated with 2 specific Japanese lake-harvested oysters and clams. From December through April, these mollusks occasionally feed on a toxic dinoflagellate that produces a potent hepatotoxin. This toxin has resulted in death from fulminant hepatic failure in 33% of cases to date.
 


More on Toxicity, Shellfish

Overview: Toxicity, Shellfish
Differential Diagnoses & Workup: Toxicity, Shellfish
Treatment & Medication: Toxicity, Shellfish
Follow-up: Toxicity, Shellfish
References
[ CLOSE WINDOW ]

References

  1. Burgess V, Shaw G. Pectenotoxins--an issue for public health: a review of their comparative toxicology and metabolism. Environ Int. Oct 2001;27(4):275-83. [Medline].

  2. Lefebvre KA, Robertson A. Domoic acid and human exposure risks: A review. Toxicon. Jun 6 2009;[Medline].

  3. Centers for Disease Control and Prevention. Update: Neurologic illness associated with eating Florida pufferfish, 2002. MMWR Morb Mortal Wkly Rep. May 17 2002;51(19):414-6. [Medline].

  4. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline]. [Full Text].

  5. Johnson RC, Zhou Y, Statler K, Thomas J, Cox F, Hall S, et al. Quantification of saxitoxin and neosaxitoxin in human urine utilizing isotope dilution tandem mass spectrometry. J Anal Toxicol. Jan-Feb 2009;33(1):8-14. [Medline].

  6. Nicholson BC, Shaw GR, Morrall J, Senogles PJ, Woods TA, Papageorgiou J, et al. Chlorination for degrading saxitoxins (paralytic shellfish poisons) in water. Environ Technol. Nov 2003;24(11):1341-8. [Medline].

  7. Ahmed FE. Seafood safety. Committee on Evaluation of the Safety of Fishery Products. Food & Nutrition Board, Institute of Medicine. National Academy Press; 1991.

  8. Chandrasekaran A, Ponnambalam G, Kaur C. Domoic acid-induced neurotoxicity in the hippocampus of adult rats. Neurotox Res. 2004;6(2):105-17. [Medline].

  9. Economou V, Papadopoulou C, Brett M, Kansouzidou A, Charalabopoulos K, Filioussis G, et al. Diarrheic shellfish poisoning due to toxic mussel consumption: the first recorded outbreak in Greece. Food Addit Contam. Mar 2007;24(3):297-305. [Medline].

  10. Gessner BD, Middaugh JP, Doucette GJ. Paralytic shellfish poisoning in Kodiak, Alaska. West J Med. Nov 1997;167(5):351-3. [Medline].

  11. Jeffery B, Barlow T, Moizer K, Paul S, Boyle C. Amnesic shellfish poison. Food Chem Toxicol. Apr 2004;42(4):545-57. [Medline].

  12. Kawatsu K, Hamano Y, Noguchi T. Production and characterization of a monoclonal antibody against domoic acid and its application to enzyme immunoassay. Toxicon. Nov 1999;37(11):1579-89. [Medline].

  13. Poli MA, Musser SM, Dickey RW, Eilers PP, Hall S. Neurotoxic shellfish poisoning and brevetoxin metabolites: a case study from Florida. Toxicon. Jul 2000;38(7):981-93. [Medline].

  14. Stommel EW, Watters MR. Marine Neurotoxins: Ingestible Toxins. Curr Treat Options Neurol. Mar 2004;6(2):105-114. [Medline].

  15. Usleber E, Dietrich R, Burk C, Schneider E, Martlbauer E. Immunoassay methods for paralytic shellfish poisoning toxins. J AOAC Int. Sep-Oct 2001;84(5):1649-56. [Medline].

  16. Vale P, Sampayo MA. Comparison between HPLC and a commercial immunoassay kit for detection of okadaic acid and esters in Portuguese bivalves. Toxicon. Nov 1999;37(11):1565-77. [Medline].

  17. Van Dolah FM. Marine algal toxins: origins, health effects, and their increased occurrence. Environ Health Perspect. Mar 2000;108 Suppl 1:133-41. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

paralytic shellfish poisoning, PSP, neurologic shellfish poisoning, NSP, diarrheal shellfish poisoning, DSP, amnestic shellfish poisoning, ASP, brevetoxin, brevotoxin, shellfish toxicity, shellfish poisoning, shellfish exposure, shellfish ingestion, hepatitis A, Norwalk virus, Vibrio parahaemolyticus, Vibrio vulnificus, toxic shellfish, saxitoxin, okadaic acid, domoic acid

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Thomas Arnold, MD, Medical Director, Louisiana Poison Control Center, Associate Professor and Chairman, Department of Emergency Medicine, Section of Clinical Toxicology, Louisiana State University Health Sciences Center
Thomas Arnold, MD 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.

Medical Editor

Robert L Norris, MD, Associate 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.

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.