Singapore Med J 2013; 54(6): e120-e122; http://dx.doi.org/10.11622/smedj.2013095
Severe bradycardia and prolonged hypotension in ciguatera
Chan TY
Correspondence: Prof Thomas YK Chan, tykchan@cuhk.edu.hk
ABSTRACT
Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.
Keywords: atropine, bradycardia, ciguatera, dopamine, hypotension
Singapore Med J 2013; 54(6): e120–e122; http://dx.doi.org/10.11622/smedj.2013095
REFERENCES
1. Chan TYK, Wang AYM. Life-threatening bradycardia and hypotension in a patient with ciguatera fish poisoning. Trans R Soc Trop Med Hyg 1993; 87:71.
http://dx.doi.org/10.1016/0035-9203(93)90428-S |
| |
| 2. Choi SMY, Wong MMH. Epidemiology of ciguatera poisoning in Hong Kong. Public Health Epidemiol Report 1994; 3:12-4. |
| |
| 3. Au A. Ciguatera fish poisoning on the rise – a review of cases (January 2004-May 2005). Communicable Diseases Watch 2005; 13:49-50. |
| |
4. Isbister GK, Kiernan MC. Neurotoxic marine poisoning. Lancet Neurol 2005; 4:219-28.
http://dx.doi.org/10.1016/S1474-4422(05)70041-7 |
| |
5. Quod JP, Turquet J. Ciguatera in Réunion Island (SW Indian Ocean): epidemiology and clinical patterns. Toxicon 1996; 34:779-85.
http://dx.doi.org/10.1016/0041-0101(95)00164-6 |
| |
| 6. Seasonal food safety tips – prevention of ciguatera fish poisoning start with choosing coral reef fish carefully. Centre for Food Safety [online]. Available at: http://www.cfs.gov.hk/english/whatsnew/whatsnew_fsf/whatsnew_fsf_poison_.... Accessed December 30, 2006. |
|
| |
7. Geller RJ, Benowitz NL. Orthostatic hypotension in ciguatera fish poisoning. Arch Intern Med 1992; 152:2131-3.
http://dx.doi.org/10.1001/archinte.1992.00400220135023 |
| |
8. Palafox NA, Jain LG, Pinano AZ, et al. Successful treatment of ciguatera fish poisoning with intravenous mannitol. JAMA 1988; 259:2740-2.
http://dx.doi.org/10.1001/jama.1988.03720180066035 |
| |
| 9. Pearn JH, Lewis RJ, Ruff T, et al. Ciguatera and mannitol: experience with a new treatment regimen. Med J Aust 1989; 151:77-80. |
| |
10. Schnorf H, Taurarii M, Cundy T. Ciguatera fish poisoning: a doubleblind randomized trial of mannitol therapy. Neurology 2002; 58:873-80.
http://dx.doi.org/10.1212/WNL.58.6.873 |
