A combination of cocaine and poisonous pufferfish sent a Florida man to the emergency room after a new case report.
The liver of a puffer fish, also called Fugu, is considered a delicacy in Japan. However, the food is risky because the fish's liver contains a high concentration of a deadly poison known as tetrodotoxin (TTX), which causes paralysis when ingested.
"Puffer fish is something you do not just want to catch and eat," Dr. Zane Horowitz, medical director at the Oregon Poison Center of Oregon Health Science University, who was not involved with the man's case. "In Japan, there are chefs who have spent years training how to cook it properly so they do not kill their customers." [In Photos: The Power of Poison Through Time]
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Since there is no antidote to TTX, doctors often place patients on respirators so they can breathe until the body excretes the poison.
The case of the 43-year-old man was more complex than that of a typical Fugu eater. In recent days, he had taken cocaine and eaten canned food, which caused his doctors to wonder if food botulism also mattered.
The man had high blood pressure (possibly due to his cocaine use) and chronic kidney disease. the doctors noticed. When he came to the emergency room, the man was not in good shape; He was vomiting, had weakness and difficulty speaking, and said he had abdominal pain, chest pain, and numb legs.
The man's grandmother, who had also gnawed on the puffer fish, came to the hospital with him. But because her Fugu portion was smaller, she had fewer symptoms: dizziness and leg weakness, the doctors said.
Health care workers immediately gave the man medication to lower his hypertension and intubated him so he could breathe when the TTX paralyzes his breathing muscles. If he had botulism, they also gave him botulinum antitoxin, the doctors reported.
The man received medications that have been proven to help other people who ate bad fugu. His recovery, however, was not easy; In the intensive care unit, the patient developed pneumonia and his kidney problems flared so that he had to be dialyzed.
"Finally, the respiratory failure of the patient was resolved, but renal function [kidney] did not recover and the patient remained dialyzed-dependent today," the physicians wrote in the case report. "The patient's grandmother underwent a much more benign clinical course and did not require intensive care management."
"The message [from the case report] is clear: & # 39; do not eat pufferfish! & # 39; Bill Atchison, Professor of Pharmacology and Toxicology at Michigan State University, who was not involved in patient care, told Live Science.
Horowitz stated that he had some questions about the patient's situation. For example, the case report says nothing about how the man acquired the puffer fish, although "there are resources in Florida to procure it, such as subterranean markets and fisheries," the doctors wrote.
If the man still had the fish "Then the Ministry of Health could have tested it on TTX," Horowitz said. If the fish had been gone long ago, the doctors would have been able to test the man for the presence of TTX to make the diagnosis, he added. [27 Oddest Medical Cases]
A clear diagnosis is important because the man may have had another co-occurring condition that was responsible for some of his symptoms, Horowitz said.
Finally, it is unclear why the doctors suspected botulism as symptoms of the male did not match those of the botulism toxin. While this poison can also cause paralysis, people with botulism poisoning have symptoms such as difficulty swallowing, difficulty breathing and sagging eyelids, Horowitz said. The case report mentions that the man ate "canned food" that may contain the toxin but does not indicate whether the food was preserved by an expert (in which case botulism would be unlikely) or an amateur, Horowitz said.
Horowitz added that the kidney dialysis was probably not caused by TTX or suspected botulism. The culprit was probably the cocaine, which can cause a blood pressure increase.
"[Cocaine isn’t] is not directly kidney-toxic in itself," said Horowitz. But "if you drink cocaine all the time or do it once and have a very high blood pressure, it will have a pretty serious impact on your kidneys."
The authors of the case report could not be reached for comment. The study was published online on June 7 in the journal BMJ Case Reports.
Originally published on Live Science .