Central Nervous System Effects of Puffer Fish (Tetrodotoxin) Poisoning

河豚毒素對中樞神經的影響：個案報告

陳浩業(Hao-Yeh Chen) ； 阮祺文(Chi-Wen Juan) ； 高大倫(Ta-Lun Kao) ； 劉正元(Chen-Yuan Liu)

《中華民國急救加護醫學會雜誌》 21卷3期 (2010/09) Pp. 162-166

https://doi.org/10.30018/JECCM.201009.0007

摘要

河豚毒素是一種神經毒素，它存在於一些淡水和海水生物當中，包括河豚魚，豹紋章魚，印度洋鰕虎，腹足綱的軟體動物，翻車魚，引金魚和硬鱗魚。大多數的案例發生於東南亞，尤其是日本，因為河豚在當地被視為一道佳餚。儘管日本政府已立法改善河豚魚的販賣與處理來降低中毒的機會，河豚中毒依然是日本食物中毒的最大死因， 因為當地人仍有許多無照廚師和未受過訓練的人來處理河豚魚。河豚毒的中毒症狀包括肢體癱瘓，呼吸衰竭，視力模糊，眩暈，感覺麻木，感覺異常，噁心和步態不穩，這些症狀包含心臟血管，呼吸，周邊神經和中樞神經等系統。本文章報告一位59歲計程車司機，吃完河豚後產生氣促，全身麻木及無力來急診就醫的病人。我們記錄病患病中及癒後的腦波，顯示大腦皮質因河豚毒素僅產生輕度大腦皮質功能異常的現象，即便病患陷深度昏迷併瞳孔放大。就現今的文獻，這個病人可能是第一個用腦波記錄河豚中毒的案例。

關鍵字

河豚毒 ； 河豚 ； 腦波

並列摘要

Tetrodotoxin (TTX) is a neurotoxin which is found in freshwater and marine species including puffer fish, blue-ringed octopus, Indo-pacific goby, gastropod mollusks, ocean sunfish, triggerfish and boxfish. The majority of reported cases have occurred in southeastern Asia, particularly Japan, where puffer fish is considered a delicacy. Although improved legislation governing marketing and preparation of the fish has reduced the incidence of puffer fish poisoning in Japan, it remains the most common cause of fatal food poisoning, as there are still some unlicensed cooks and untrained workers involved in preparing the fish. Symptoms of poisoning include paralysis, respiratory failure, blurred vision, vertigo, numbness, paresthesia, nausea and ataxia, which involve the cardiovascular, respiratory, peripheral and central nervous systems. We report a 59-year-old male taxi driver, who presented to our emergency department with dyspnea, generalized weakness and numbness due to tetrodotoxin poisoning. We recorded changes in the patient's electroencephalogram (EEG) during and after the illness. To our knowledge, this is the first report in humans demonstrating only minor cortical dysfunction on an EEG during severe tetrodotoxin poisoning in a patient in a deep coma with fixed, dilated pupils.

並列關鍵字

tetrodotoxin ； puffer fish ； electroencephalogram EEG