Shellfish Toxicity Treatment & Management

Updated: Dec 28, 2015
  • Author: Thomas C Arnold, MD, FAAEM, FACMT; Chief Editor: Asim Tarabar, MD  more...
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Prehospital Care

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


Emergency Department Care

See the list below:

  • 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.