There are 2 naturally occurring seafood neurotoxins: 1) tetrodotoxin produced by puffer fish, and 2) saxitoxin produced by microalgae in bivalve shellfish [37] . The toxins bind to voltage-gated sodium channels, inhibiting membrane depolarization and the conduction of action potentials [96, 97] . Both cause a severe paralysis of rapid onset. Numbness and tingling are often prominent, starting periorally before spreading to the limbs; GI distress, anxiety, headache, and mild peripheral weakness may appear within minutes to a few hours after ingestion. Successively, an ascending paralysis develops. Bulbar symptoms, hypersalivation, and sweating are commonly encountered. Hypotension (tetrodotoxin [97] ) or hypertension (saxitoxin [96] ), convulsions, and cardiac arrhythmias can occur. Death ensues secondary to respiratory failure within 24 h [37] . The victims may remain fully conscious.