All exhibited marked lessening of neurologic and muscular dysfunction within minutes of the administration of mannitol. Gastrointestinal symptoms disappeared more slowly. Two patients in coma and one in shock responded within minutes, with full recovery after infusion. 6 Consumption of affected fish, whether it is cooked, raw, or frozen, may result in poisoning. 7 Symptoms usually appear within 12 hours, 8-10 but sometimes they appear within minutes after the ingestion of ciguatoxin.
Clinical presentation varies from minor complaints to coma and death.
Paresthesias, burning or pain when cold water is touched, arthralgias, and myalgias are common. 1,2,8,11 Abdominal pain, cramping, diarrhea, nausea, and vomiting are less prominent. Paresis, hypotension, and shock occur in some victims. Coma, paralysis, respiratory depression, and death have all been reported. 10 Laboratory data are nonspecific.