Diarrhetic Shellfish Poisoning (DSP) may occur following ingestion of shellfish that have fed on dinoflagellates producing gastrointestinal toxins.
Toxins: derivatives of okadaic acid
(1) lipid soluble
(2) long term exposure may result in development of gastric carcinomas
Timing:
(1) onset ranges from 30 minutes to 2 hours (rarely longer) after ingestion
(2) duration 2 to 3 days
Presenting symptoms:
(1) nausea and vomiting
(2) abdominal pain
(3) diarrhea
Severity of Syndrome
Symptoms
mild to moderate
severe diarrhea
vomiting
dehydration
severe
shock in debilitated elderly patients
Paralysis does not occur.
Mortality rate: may occur rarely in a debilitated elderly patient who develops shock.
The differential diagnosis includes infection from Vibrio and other enteric bacteria. The shellfish and patient stool should be cultured for enteric pathogens.
If more than one person was exposed, the spectrum of findings amongst all of the persons may help reach a final diagnosis.
Management:
(1) Supportive care is usually adequate.
(2) Intravenous fluid support with dehydration.
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