One evening during a recent trip to Indonesia, Dr. Marshall Westwood sat down to

Question

One evening during a recent trip to Indonesia, Dr. Marshall Westwood sat down to a meal of puffer fish and rice. Within an hour of returning to his hotel room. Dr. Westwood felt numbness in his lips and tongue, which quickly spread to his face and neck. Before he could call the front desk, he began to feel pains in his stomach and throat, which produced feelings of nausea and eventually severe vomiting. Fearing that he had eaten some "bad fish" for dinner, Dr. Westwood called a local hospital to describe his condition. The numbness in his Ups and face made it almost impossible for him to communicate, but the hospital staff managed to at least understand the address he gave them and they sent an ambulance. As Dr. Westwood was rushed to the hospital, his breathing became increasingly labored. The patient presented in the ED with diaphoresis, motor dysfunction, paresthesias, nausea, and an ascending paralysis that started in his legs and spread to the upper body, arms, face, and head. The patient was cyanotic and hypoventilating. Within 30 minutes of presenting in the ED, Dr. Westwood developed bradycardia with a BP of 90/50 mmHg. Atropine was administered in response to the bradycardia. Intravenous hydration, gastric lavage, and activated charcoal followed a presumptive diagnosis of tetrodotoxin poisoning that was based on the clinical presentation in the ED. Five hours after treatment, the following vital signs were noted: BP 125/79 mmHg HR 78 bpm Oxygen saturation: 97% on room air After discussing his case with his physician, he learned that he had probably been the victim of puffer fish poisoning. The active toxin in the tissues of this fish is a chemical called tetrodotoxin (TTX). Tetrodotoxin is in a class of chemicals known as neurotoxins because it exerts its effects on neurons. The specific action of tetrodotoxin is that it blocks voltage-gated sodium ion channels. Define the following phrases and, terms associated with the signs and symptoms of Dr. Westwood's TTX poisoning: diaphoresis motor dysfunction paresthesias cyanotic hypoventilating bradycardia gastric lavage oxygen saturation

Explanation / Answer

Diaphoresis: It is the condition of excess sweating or perspiration due to misfunctioning of temperature regulatory system of the body due to elevated activity of sweat glands by the autonomic nervous system.

Motor dysfunction: It is the non functioning of muscles leading to weakening , nervous system effecting movement of certain organs.

Paresthesias: It is the sensation of the body due to prickling or burning leading to numbness in legs, feet, hands. It is usually painless.It is due to neurological disorder in CNS, encephalitis, ischemic attacks.

Cyanosis : The appearence of blue or purple pigmentation of skin or mucous membrane tissues due to elevated level of deoxygenated hemoglobin above 5g/dL.

Hypoventilation: It is the condition of breathing disorder where the air entering alveoli of lungs decreases due to low concentration of oxygen, high concentration of CO2 or respiratory acidosis.

Bradycardia: t is the condition where heart beats slowly less than 60beats per minute leading improper exchange of oxygen and nutrients.It is due to non functioning of sinoatrial node.

Gastric lavage : Gastric lavage is the pumping of stomach where the process involve elimination of poisons or overdosed drugs from the stomach by inserting a tube containing saline solution or liquid either through mouth or nose through eosophagus into the stomach. It is also known as nasogastric tube suction.

Oxygen saturation: (SO2): It is the amount of oxygen dissolved or carried at maximum level by a carrier molecule like blood.The oxygen saturation level with 95% to 100% is considered as normal level.

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