Ciguatoxin causes an increase in parasympathetic tone and impairs sympathetic reflexes. Symptoms begin from a few hours to 3 days after the meal and may become chronic. Dehydration is common from GI loss. Neurologic findings are extremely variable and may range from mild to life threatening. Cardiac findings may manifest as shock.
Treatment is largely supportive and symptom driven.
If performed within 3-4 hours of toxin ingestion, gastric decontamination followed by activated charcoal may help. Avoid administering syrup of ipecac because of its potential to worsen fluid losses. Antiemetics may control nausea and vomiting. Cool showers and antihistamines help relieve pruritus. Mannitol infusion can help alleviate neurologic symptoms.