Tetrodotoxic Poisoning from Ingestion of a Porcupine Fish (Diodon hystrix) in Papua New Guinea: Nerve Conduction Studies

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  • Department of Clinical Sciences, University of Papua New Guinea, Port Moresby General Hospital, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Boroka, Papua New Guinea

Near Port Moresby in Papua New Guinea, three of four adult family members who ate a porcupine fish (Diodon hystrix) were severely poisoned. Within one hour of the meal, both the mother and her older daughter had developed paraesthesiae, ataxia, hypersalivation, sweating, and had collapsed and died. The younger daughter developed similar symptoms with progressive paralysis requiring mechanical ventilation for 24 hr, but she made a complete recovery 10 days after the poisoning. In this patient, nerve conduction studies showed reduced sensory and motor conduction velocities and evoked amplitudes with gradual improvement in parallel with the patient's clinical condition, consistent with the known action of tetrodotoxin on voltage-gated sodium channels.