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Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Puffer Fish Poisoning in Thailand

Puffer Fish Picture
A recent news report commented upon the fact that vendors in Thailand have been selling puffer fish meat and calling it salmon. According to a reporting physician in Thailand, this disguised (dyed in some cases) puffer fish meat has caused at least 15 deaths over the past year.

Certain puffers ("blowfish," "globefish," "swellfish," "porcupinefish," and so on) contain tetrodotoxin, one of the most potent poisons in nature. These fish are prepared as a delicacy (fugu) in Japan and elsewhere by specially trained and licensed chefs. People intentionally eat puffer fish for the culinary thrill, which when causing the sought-after effects, generates a set of minor, non-debilitating symptoms of what can become a very serious, even fatal, intoxication (see below).

The toxin is found in the entire fish (including the flesh, or "meat"), with greatest concentration in the liver, intestines, reproductive organs, and skin. After the victim has eaten the fish, symptoms can occur as quickly as 10 minutes later or be delayed by a few hours. These include numbness and tingling around the mouth, lightheadedness, drooling, sweating, vomiting, diarrhea, abdominal pain, weakness, difficulty walking, paralysis, difficulty breathing, and collapse. As noted above, this ingestion can be fatal. Tetrodotoxin is also found in other animals; for instance, it is the toxin responsible for the potentially lethal bite of the Indo-Pacific blue-ringed octopus.

If someone is suspected or known to be suffering from puffer poisoning, he or she should immediately be transported to a hospital. Pay attention to their ability to breathe, and assist breathing if necessary. This may necessitate using a bag-valve-mask device, or in the absence of a doctor or emergency medical technician, using mouth-to-mouth breathing, preferably with a barrier shield.

Unfortunately, there is no antidote for tetrodotoxin poisoning, and the victim will need sophisticated medical management until the toxin is eliminated from the body. Eating puffers, unless they are prepared by the most skilled chefs, is dietary Russian roulette. Persons should now, obviously, be extremely careful when purchasing fish from vendors in Thailand.

photo by Ken Kizer

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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