More rapid onset of symptoms is associated with higher levels of toxin ingestion. Symptoms principally are neurologic and cardiovascular in nature and may include perioral tingling, a floating sensation, a feeling of overall warmth, weakness, incoordination, slurred speech, bradycardia, hypotension, and dyspnea. Decreased levels of consciousness, seizures, and death have occurred in as few as 17 minutes. TTX is concentrated in organ meat and gonads. TTX binds specifically to and blocks nerve cell sodium channels.
Care is supportive.
Gastric lavage and charcoal are indicated in cases of early presentation. Atropine, pressors, and IV fluids can be used for cardiovascular instability. Patients who present with mild symptoms may be observed and discharged at 8 hours if symptoms have diminished. The incidence of pufferfish poisoning is decreasing, presumably because of heightened awareness and proper preparation of fish. Sardine poisoning Sardine poisoning is rare and episodic.