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Medicine (MD/DO)
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First Aid
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First Aid for the USMLE Step 1 (2023)
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Tetrodotoxin

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Tetrodotoxin

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Tetrodotoxin

Tetris with toxic-green-glow
DikeHAfifi
11 KEY FACTS
SOURCE
Pufferfish
Pufferfish

Tetrodotoxin is a potent neurotoxin found in pufferfish. It is known as one example of marine toxins in food poisoning and is commonly served at fugu restaurants.

MECHANISM
Blocks Voltage-Gated Na+ Channels
Block-guy-blocking Electric-gate Salt-shaker Channel

Tetrodotoxin blocks voltage-gated Na+ channels that are used for nerve impulses. This blockage prevents depolarization, causing weakness, paralysis, paresthesia, and reflex loss.

Prevents Depolarization
Prevent D-polar-bear

Prevention of depolarization will cause inhibition of nerve conduction. Patients will experience nerve problems such as weakness, paralysis, paresthesia, and reflex loss.

SIGNS AND SYMPTOMS
Weakness
Weak-drooping-muscle

Weakness is one of the early manifestations of tetrodotoxin poisoning. It is caused by the toxin's blockade of sodium channels on the nerve cell membrane.

Dizziness
Dizzy-eyes

Paresthesia can either precede or occur simultaneously with headache, weakness, or dizziness.

Paresthesia
Paris-t-shirt with Pins-and-needles

Paresthesia of the face and extremities, described as tingling, can be experienced by patients.

Nausea
Vomiting

Patients affected by tetrodotoxin can experience clinical manifestations within 30 minutes of consumption. Nausea and vomiting can occur due to the action of toxins directly at or near the chemoreceptor trigger zone.

Diarrhea
Toilet

Diarrhea can occur as a gastrointestinal symptom of tetrodotoxin. Another potential symptom is abdominal pain.

Loss of Reflexes
Loss of Reflex-hammer

Symptoms of tetrodotoxin poisoning can progress to a loss of reflexes.

Paralysis
Wheelchair

Patients can experience skeletal muscle paralysis, which can affect the respiratory tract. As a result, the effects of this toxin can lead to respiratory arrest and death.

MANAGEMENT
Supportive
Supportive IV-bags

Tetrodotoxin treatment is supportive, based on the patient's clinical features. These may include symptomatic therapies, mechanical ventilation, intravenous fluids, and vasopressors.

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