Puffer Fish Case Study

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Summary of case study

This case study describes patient Dr. Westwood. Dr. Westwood started to show symptoms within an hour after he ate puffer fish and rice for dinner. Patient felt numbness in his lips and tongue, which spread on his face and neck. After that he started to feel pains in his stomach and throat, patient started to feel nauseas and later severe vomiting started. In spite of difficulty communicating due to numbness patient was able to call ambulance and was delivered to ED. By that time Dr. Westwood had diaphoresis, motor dysfunction, paresthesias, nausea and an ascending paralysis. Dr. Westwood was cyanotic and hypoventilating. He developed bradycardia with a BP of 90/50 mmHg. Based on observed symptoms conclusion was made
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Westwood had. Tetrodotoxin is a blocker of voltage gated sodium channels of the excitable tissues like nerves and muscles. It prevents movement of sodium ions through these channels which affect action potential generation in nerves which is why Dr. Westwood experienced numbness after eating the puffer fish.
Tetrodotoxin affects all excitable tissues, nerves and muscle, by binding to the sodium ion channels and preventing sodium to get into the cell. This will affect conductivity of nerve and prevent action potential from traveling down the axon. Without action potential reaching the neuromuscular junction no neurotransmitters will be released and transferred to the muscle and no muscle contraction will occur. On top of that tetrodotoxin affects sodium channels inside muscles which also can cause motor dysfunction.
Overall poisoning by tetrodotoxin is a very dangerous condition and people shouid be very careful eating puffer
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Table 1

Paresthesias A prickly, tingling sensation
Diaphoresis The secretion of sweat, especially the profuse secretion associated with an elevated body temperature, physical exertion, exposure to heat, and mental or emotional stress motor dysfunction abnormality of the motor system
Cyanotic Marked by bluish discoloration of the skin due to a lack of oxygen in the blood
Hypoventilating Reduced or deficient ventilation of the lungs, resulting in reduced aeration of blood in the lungs and an increased level of carbon dioxide in the blood
Bradycardia Slowness of the heartbeat, so that the pulse rate is less than 60 per

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