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Understanding seafood toxins is crucial for the USMLE Step 1 exam, particularly in identifying toxin actions, sources, symptoms, and treatment strategies. These toxins impact sodium (Na⁺) channels or involve histamine release, leading to distinct clinical syndromes.
Toxin | Source | Action | Symptoms | Treatment |
---|---|---|---|---|
Histamine (Scombroid Poisoning) | Spoiled dark-meat fish (e.g., tuna, mackerel) | Converts histidine to histamine via bacterial enzymes | Mimics anaphylaxis: burning mouth, flushing, erythema, itching, bronchospasm, angioedema, hypotension | Antihistamines; epinephrine/albuterol if needed |
Tetrodotoxin | Pufferfish | Blocks Na⁺ channels, inhibiting depolarization | Nausea, diarrhea, paresthesias, dizziness, weakness, loss of reflexes | Supportive care |
Ciguatoxin | Reef fish (e.g., barracuda, snapper) | Opens Na⁺ channels, causing depolarization | Nausea, vomiting, diarrhea, perioral numbness, hot-cold sensation reversal, bradycardia, heart block, hypotension | Supportive care |
When a patient presents with gastrointestinal symptoms, paresthesias, or unusual sensory changes after consuming seafood, always consider seafood toxins in the differential diagnosis.