Shellfish Toxicity Treatment & Management

  • Author: Thomas C Arnold, MD, FAAEM, FACMT; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 6, 2011
 

Prehospital Care

Support and maintenance of the airway are of crucial importance in PSP.

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Emergency Department Care

  • Therapy for all shellfish poisonings is supportive and symptom-driven.
  • Gastrointestinal decontamination with activated charcoal is recommended for patients who present within 4 hours of ingestion. Nasogastric or orogastric lavage may be performed if the patient presents within 1 hour of ingestion, but this is often unnecessary.
  • If gastric lavage is performed, the use of isotonic sodium bicarbonate solution as a lavage irrigant has been suggested because many of the shellfish toxins have reduced potency in an alkaline environment.
  • Okadaic acid undergoes enterohepatic recycling that could be interrupted by delayed or repeat charcoal administration.
  • The greatest danger is respiratory paralysis. Close monitoring for at least 24 hours and aggressive airway management at any sign of respiratory compromise should prevent severe morbidity and mortality.
  • Neostigmine and edrophonium have been used to improve muscle weakness following tetrodotoxin intoxication, which is similar to saxitoxin intoxication. Nonetheless, no clinical trials have evaluated the use of these drugs for saxitoxin exposures.
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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

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 & 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

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

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  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].

 
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