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Tetrodotoxin

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Critical Care Toxicology

Abstract

Tetrodotoxin (TTX) with a toxicity more than 1000 times greater than sodium cyanide (median lethal dose approximately 10 μg/kg versus 10 mg/kg for sodium cyanide) is one of the most potent marine poisons known [1–3]. It also may be the best known marine toxin, because it is responsible for puffer fish poisoning (fugu or Tetraodon poisoning), which has caused many fatalities, particularly in Japan. Although puffer fish poisoning has been associated with a high fatality rate in Japan for centuries, the danger of puffer fish consumption has long been recognized in other countries, including China and Egypt [3, 4]. The first Chinese pharmacopoeia, the Book of Herbs (Pen-T’so Chin), usually attributed to the legendary Emperor Shun Nung (2838–2698 bc), listed puffer eggs as one of the 120 medium drugs that were believed to have tonic effects but could also be toxic, depending on the dose [3]. A detailed description of the appearance and general toxic properties of a puffer fish (known as “piglet of the river” in Chinese, likely representing Tetraodon oscellatus) was given in the most authoritative pharmacopoeia of traditional Chinese medicine, The Great Herbal (Pen-T’so Kang Mu), by Li Shih-Chen in 1596 ad [3]. A puffer fish identified as Tetraodon lineatus is shown on an Egyptian tomb from 2500 bc, and there is evidence that the Egyptians knew the poisonous nature of this fish [4].

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Authors and Affiliations

  1. Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Chen-Chang Yang

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Correspondence to Chen-Chang Yang .

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Editors and Affiliations

  1. Department of Medicine, Division of Clinical Pharmacology and Toxicology, University of Colorado, School of Medicine, Aurora, Colorado, USA

    Jeffrey Brent

  2. FDA, Office of New Drugs/Immediate Office, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas’ Hospital, Silver Spring, Maryland, USA

    Paul Dargan

  4. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Benjamin Hatten

  5. Medical Toxicological Intensive Care Unit, Lariboisiere Hospital, Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. Toxicology Associates, University of Colorado, School of Medicine, Denver, Colorado, USA

    Robert Palmer

  7. Toxinology Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

    Julian White

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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Yang, CC. (2017). Tetrodotoxin. In: Brent, J., et al. Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-17900-1_39

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