Toxins:
(1) heat stable, water soluble, tetrahydropurines
(2) principal form: saxitoxin and its derivatives (referred to as gonyautoxins)
(3) may be lethal at doses as low as 0.1 mg
Timing:
(1) onset about 1 hour after ingestion (range 0.5 to 3 hours)
(2) duration 2 to 5 days
Presenting symptoms (may be missed if the patient is sleeping at the time of onset):
(1) paresthesias of the mouth, lips and/or throat
(2) disequilibrium, floating feeling
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Severity of Syndrome
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Symptoms
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mild to moderate
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generalized paresthesias
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weakness of arms and legs
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headache
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ataxia
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nausea and/or vomiting
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severe
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dysphagia
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dysarthria
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diplopia
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limb paralysis
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respiratory failure
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Mortality rate:
(1) averages 5.9% (may be up to 44%)
(2) Children appear to be at a higher risk for mortality.
(3) Usually associated with respiratory failure.
(4) May occur as soon as 2 hours after exposure.
Management:
(1) CPR may be needed for acute arrest.
(2) Respiratory support and intensive care can maintain the patient during the acute phase of the syndrome.
(3) All exposed persons should be assessed and observed irrespective of symptom severity due to potential risk.
