A rapid ascending paralysis occurs over 4-24 hours. Extremity paralysis precedes bulbar paralysis, which then is followed by respiratory muscle paralysis. Deep tendon reflexes are preserved early in the course of paralysis. Patients with severe toxicity may have deep coma, fixed nonreactive pupils, apnea, and loss of all brain stem reflexes. Death can occur within 4-6 hours.
Death typically occurs from respiratory muscle paralysis.
A death from ingestion of tetrodotoxin from a California newt has been documented. No specific laboratory test that confirms tetrodotoxin ingestion exists. Thus, the dietary history is key. Tetrodotoxin also may be detected by fluorescent spectometry. Routine serum electrolytes, calcium, magnesium, and ABGs should be measured to rule out metabolic causes of diffuse sensory and motor neuron dysfunction.