Clinical Flowchart

Autopharmacological effects

Scombroid fish poisoning

Minutes (to hours)

Nausea, vomiting, abdominal pain, diarrhoea, urticaria, angio-oedema, bronchospasm, arterial hypotension

All forms of poisoning due to poisonous animals

Minutes to hours

Nausea, vomiting, diarrhoea, abdominal pain

Hypovolaemia

Not observed.

Tetrodotoxin poisoning PSP (NSP) Ciguatera ASP
Minutes to hours

Tetrodotoxin poisoning PSP (NSP)	Ciguatera	ASP

Acroparaesthesias	Numbness, tingling, itching (palms of the hands, soles of the feet, lips, oral mucosa). Temperature dysaesthesias: Painful tingling or burning sensation to cold objects, air, fluids.	Confusion, lethargy,short-term memory loss

Paralysis, including respiratory muscles	Loss of consciousness, multiple CNS disturbances	Seizures, coma

Respiratory failure	CNS failure, cardio-respiratory failure	CNS failure

PSP = Paralytic shellfish poisoning

NSP = Neurotoxic shellfish poisoning

ASP = Amnesic shellfish poisoning

Ciguatera

Hours

Myalgia

Ciguatera
Tetrodotoxin poisoning
ASP

Minutes to hours

Cardiac dysrhythmias

Arterial hypotension

Heart failure

ASP = Amnesic shellfish poisoning

Not observed.