Am J Pub Hlth 1991;81:471

Cause:Ingestion of shellfish contaminated with dinoflagellate (red tide) neurotoxin; when occurs with fish is called ciguatera poisoning (see scombroid)

Occurs in epidemics

Sx:Cooking does not prevent; onset in 0.5-10 h. Paresthesias (81%); reversal of hot/cold sensations (17%); vertigo (60%); myalgias; abdominal pain (48%); nausea (44%); rectal burning; headache (15%)

Si:Ataxia (27%); bradycardia; dilated pupils

8-48 h

Rx:Charcoal, respiratory support; mannitol 1-2 gm/kg; possibly calcium channel blockers, lidocaine