There is a drug called mannitol that can be given intravenously. It's most effective if administered during the first 72 hours, but can help up to eleven weeks after poisoning. We left Nassau after recovering for three weeks, still having to take hourly shifts at the helm. We arrived in Miami and were treated with mannitol at the University of Miami Hospital. The mannitol helps with the severe muscle weakness and joint pains, but doesn't help with the itching, cold to hot reversal, or some of the other more minor symptoms.
Symptoms vary and can begin within a few minutes to a few hours of ingestion of the toxic fish.
A person can have one or all of the symptoms, such as we did, depending on the toxicity of the fish. We've learned that consumption of alcohol of any amount can cause a re-occurrence of the original poisoning symptoms. Eating fish, nuts, chocolate, and other foods can also cause a relapse. Symptoms can linger for months, even years, mine lingered for at least a year with frequent relapses. Fish that are suspect for ciguatera are barracuda, amberjack, grouper, hog fish, and large red snapper, yellowtail snapper, and many other large predatory fish that feed off of the smaller reef fish.