Treatment

Acutely, the primary management of the Marine and Freshwater Toxin diseases is supportive treatment. For example, for the seafood ingestion diseases, intravenous fluid replacement with electrolytes may be necessary if there is considerable diarrhea and vomiting. For some of the more acutely severe seafood ingestion illnesses such as PSP and Fugu, it may be necessary to provide ventilatory support for 24-48 hours to prevent acute respiratory arrest. Although very little information exists concerning the aerosolized marine and freshwater toxin illnesses, anecdotally removal from the aerosol exposure area and exposure to air conditioned filtered air may relieve many of the acute upper respiratory symptoms.

Ciguatera Fish Poisoning is one of the few Marine and Freshwater Toxin diseases with a double blind clinical trial to evaluate the use of intravenous Mannitol (Bagnis et al. Med Trop 1992;52:67-73). Intravenous Mannitol (1 g/kg given rapidly over 1 hour) is apparently effective in treating not only the acute gastrointestinal effects of Ciguatera, but also in preventing the chronic neurologic sequellae. Of note, IV Mannitol treatment has been found to be most effective within 3 days of consumption of the contaminated fish, and several repeat treatments may be necessary.

The known chronic sequellae of these diseases range from apparently irreversible memory loss with ASP to chronic debilitating paresthesias with Ciguatera. There are no known treatment for the former. A wide range of medications have been tried in the treatment of chronic Ciguatera, with no published double blind clinical trials to date. In the literature, the tricyclic anti-depressants (particularly Elavilr), Prozacr and similar medications have been reported to relieve some of the paresthesias in case reports; calcium channel blockers and non steroidal anti-inflammatory medications have also had reports of successful cases. Of note, vitamins, steroids and anti-histamines have not been shown to be efficacious. In the case of Ciguatera, there are considerable anecdotal reports of increased acute and chronic symptoms with the consumption of alcohol, caffeine, nuts, chocolate, and any type of fish.