Paihana Ika Ciguatera (He Huringa Wera-Matao, Bradycardia) ki te Scombroid Histamine Fish Flush me te Paitini Maataitai¶

Ko te pupuhi ohorere huri noa i te waha, ka wera te kiri ina pa ki te wai matao, te whero kanapa o te kanohi, te whanoke, te uaua manawa ranei i muri tata i te kai i te ika akau, i te paopao, i te maataitai bivalve ranei me tere te rereketanga haumanu i waenga i nga koiora moana nui. Waea atu ki to nama whawhati tata (911 i te United States me Kanata, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom) korero ranei ki a maatau whaiaronga tau ohorere o te ao i te wa tonu ka whakaatu te kai kai i te puhoi o te ngakau, te iti o te toto toto, te wheehe, te rangirua, te ngoikore ranei o nga uaua. Na te mea ko te Scombroid fish poisoning he rite tonu te ahua o te IgE-whakawaenga tauhohenga mate mate anaphylaxis ranei, i te mea ko Ciguatera, Domoic Acid, me Brevetoxin hei whakakii i to maatau whanui he aratohu whakamatautau neurotoxin mo te botulism me te paralytic shellfish, me wehe ano hoki e nga kaiwhakautu enei paitini wera mai i te huakita paihana kai me te gastroenteritis whakapeka.

Te tunu, te kohua, te parai, te tunu, te kai paipa, te tio, te whakamau ika ranei ki te wai kotakota (ceviche) KORE e whakangaro i enei paitini moana. I tua atu, he rite tonu te ahua, te hongi, me te reka o nga ika kawa me te maataitai (haunga te ngau pepa, ngau konganuku ranei i etahi wa). Ko nga kairorohiko ohorere me nga kaimori haere me wehewehe i waenga i nga mate nui e wha o te moana: 1. Ka paihana ika Ciguatera (CFP): I takea mai i te kai i nga ika nui o te ngahuru/te-a-te-a-whare (barracuda, grouper, red snapper, amberjack, moray tuna, hogfish, Spanish mackerel, coral trout) kei roto ciguatoxins (CTX) i whakaemihia mai i te dinoflagellate benthic Gambierdiscus toxicus. Ka pa mai ki te gastroenteritis whakapeka (2 to 12 hours), he whakararu ora sinus bradycardia me te hypotension, me te pathognomonic cold allodynia (hot-cold temperature reversal), ka tukinotia i roto 48 to 72 hours me te uru ki roto 20% Mannitol (1.0 g/kg) me tetahi kai kaha 6-marama keu-aukati. 2. Scombroid (Histamine) Te Pahana Ika: Na te kai i nga ika kai pouri (tuna, mahi-mahi [dorado], bluefish, mackerel, bonito, marlin, sardines, anchovies) ka huri te huakita mata i te uaua L-histidine ki te rahinga nui o histamine. Ka whakaatuhia i roto 10 to 60 minutes he mea whakaari ** "rite ki te wera" histamine rewharewha**, te mahunga pupuhi, te palpitations, me te bronchospasm, he tere te rongoa ki te H1 me te H2 antihistamines (not permanent fish allergy). 3. Maataitai Amnesic Poisoning (ASP - Domoic Acid): Na te Pseudo-nitzschia te puāwaitanga o te diatom i roto i te kuku, i te pipi heu, i te scallops, me te Dungeness crab viscera; he whakahihiri i te hippocampal AMPA/kainate glutamate receptors, ka puta te mate epilepticus me te te ngaronga mahara mo te wa poto o te anterograde. 4. Neurotoxic Shellfish Poisoning (NSP - Brevetoxin): Na Karenia brevis ("Florida / Gulf of Mexico red tide") nga dinoflagellates i roto i te tio me te pipi; ka whakahohe i nga hongere konutai ngaohiko (penei i te ciguatoxin) ki te whakaputa cold allodynia, paresthesia, me te aerosolized bronchospasm takutai kore he paralysis.

+-------------------------------------------------------------------------+
|            MARINE SEAFOOD TOXIN RAPID DIFFERENTIATION MATRIX            |
+-------------------------------------------------------------------------+
|  1. CIGUATERA FISH POISONING (Barracuda, Grouper, Snapper, Amberjack)   |
|     * Toxin: Ciguatoxin (Locks open Na+ channels) -> Onset 2 to 12 hrs  |
|     * Hallmarks: Cold Allodynia (Ice feels like burning fire), Tooth    |
|       ache/loose-tooth sensation, Severe Bradycardia (HR < 45) & Low BP |
|     * Treatment: IV Atropine + Fluids; IV 20% Mannitol (1 g/kg over     |
|       30-45m AFTER full rehydration, within 48-72h) + 6-Month Diet      |
+-------------------------------------------------------------------------+
|  2. SCOMBROID HISTAMINE POISONING (Tuna, Mahi-Mahi, Mackerel, Bluefish) |
|     * Toxin: Bacterial Histamine (from warm storage) -> Onset 10-60 min |
|     * Hallmarks: Peppery/metallic taste, Bright Red Face/Neck Flush,    |
|       throbbing headache, tachycardia, diarrhea (NOT a true allergy)    |
|     * Treatment: IV/PO H1 Blocker (Diphenhydramine/Cetirizine) + H2     |
|       Blocker (Famotidine 20 mg IV); Epinephrine only if bronchospasm   |
+-------------------------------------------------------------------------+
|  3. AMNESIC SHELLFISH POISONING (Mussels, Razor Clams, Crab Viscera)    |
|     * Toxin: Domoic Acid (Glutamate excitotoxin) -> Onset 15m to 38 hrs |
|     * Hallmarks: Vomiting -> Confusion, Status Epilepticus, Permanent   |
|       loss of short-term memory (Hippocampal necrosis)                  |
+-------------------------------------------------------------------------+
|  4. NEUROTOXIC vs. PARALYTIC SHELLFISH POISONING (Oysters, Clams)       |
|     * NSP (Brevetoxin): Na+ channel opener -> Cold allodynia, NO apnea  |
|     * PSP (Saxitoxin): Na+ channel blocker -> Rapid respiratory arrest  |
+-------------------------------------------------------------------------+

Mahia tenei inaianei¶

1. Whakaarohia te manawa, te tere o te ngakau, me te pehanga toto, ka waea atu ki nga ratonga ohorere. Waea 911 (US and Canada), 112 (Uniana Pakeha), 999 (United Kingdom), 000 (Australia), 111 ranei (Aotearoa).
2. Mena i kai te tangata i tuna, mahi-mahi ranei 15 minutes i mua, inaianei kua wheehe, korokoro, tetere te arero (Scombroid kino), tukuna he epinephrine auto-injector (EpiPen) ki roto i te huha o waho mena e waatea ana, ka hoatu a-waha diphenhydramine (Benadryl, 25 to 50 mg) ranei cetirizine (10 mg) me famotidine (Pepcid, 20 mg) mena ka taea e ratou te horomia marie.
3. Ki te kai te tangata i te barracuda, grouper, tamu whero, amberjack ranei 2 to 8 hours i mua, ka ngenge, ka ngenge ranei na te tere puhoi (below 50 beats per minute) (Ciguatera), whakatakotoria ki runga i te tuara me te hiki o nga waewae 30 centimeters (12 inches) kia mau tonu te rere o te toto ki te roro i te wa e tatari ana ki nga paramedic me te atropine me te tote noa.
4. Mahia te taha o te moenga "Whakamatau Mea Matao" mo Ciguatera, Brevetoxin ranei. Me pa atu te turoro ki tetahi ipu houra matao, he tio tio, he wai pata makariri ranei. Mena he rite te ahua o te mea matao ** te ahi e wera ana, te huka maroke, te ru hiko (cold allodynia / hot-cold temperature reversal)**, ko te matetanga ko te Paiona Ika Ciguatera (mehemea i kainga nga ika o te toka) ranei Neurotoxic Shellfish Poisoning (Brevetoxin) (mehemea i kainga te Moana-a-Kiwa o Mexico / maataitai iti). (Gulf of Mexico)
5. Kaua rawa e inu i te wai tio me te kaukau matao mena ka whakapaehia a Ciguatera. Ko te inu wai matao ka pa te mamae o te wera ki te korokoro me te esophagus, me te wai matao ki runga i te kiri ka pa te mamae mamae. Hoatu anake te pawera-ruma, he wai whakamahana-a-waha ranei i roto i nga momi iti.
6. Kia whakarite kia whakakahangia te wai whakaroto i mua i te hoatutanga i te Mannitol Intravenous mo Ciguatera. Korero atu ki te rata whawhati tata kei te mate te manawanui Paona ika Ciguatera i roto i te 48 to 72 hour Matapihi mo ** Intravenous 20% Mannitol (1.0 gram/kg)**. Heoi, na te mea he kaha osmotic diuretic te mannitol me te Ciguatera ka nui te ruaki moata me te mate korere, me whaowhia te mannitol i muri i te hypovolemia me te matewai kua oti te whakatikatika. 1 to 2 liters o crystalloids intravenous isotropic (0.9% te tote noa, te Ringer Lactated ranei).
7. Tiakihia, whakatiohia te toenga ika, maataitai ranei ka whakatupato i era atu kai kai katoa. Takaia nga toenga kai kore maoa, maoa ranei o te kai ki te pepa, ki te peeke kirihou ranei ka whakatio mo te whakamatautau biotoxin a te tari hauora (FDA / state marine lab liquid chromatography-mass spectrometry). Whakapaa atu ki nga tangata katoa i tohatoha i te ika.

Rakau whakatau: Te whakamatautau paihana o te ika moana me te maataitai¶

flowchart TD
    A["Te mate kino i muri i te kai ika moana, maataitai ranei"] --> B{"He aha te momo kaimoana i kainga?"}
    B -->|"He ika Pelagic Meat-Pouri (Tuna, Mahi-Mahi, Mackerel, Bluefish, Sardines)"| C{"Ka timata i roto i te 10-60 Minuti me te Maama Whero Whero Mata/Kaki Me te Tachycardia?"}
    B -->|"Nga Ika Moana-a-Kiwa/Tararo (Barracuda, Grouper, Snapper, Amberjack, Tuna)"| D{"Gastroenteritis (2-12h) + Cold Allodynia, Niho mamae, Bradycardia ranei?"}
    B -->|"Maataitai Bivalve (Mussels, Clams, Oysters, Scallops) Crab Viscera ranei"| E{"Te wehewehe i te mate maataitai ma nga tohu neurological"}
    C -->|"Ae"| F["SCOMBROID (HISTAMINE) IKA PAINA: Homai IV/PO H1 Blocker (Diphenhydramine 25-50 mg) + H2 Blocker (Famotidine 20 mg IV); Albuterol/Epi ki te Wheezing"]
    D -->|"Ae"| G["CIGUATERA FISH POISONING (CFP): Whakaora Tuatahi me te 1-2 L IV 0.9% Saline + IV Atropine (0.5-1 mg) mo te Bradycardia/Hypotension"]
    G --> H["Kia Euvolemic (me i roto i te 48-72h): Infuse 20% IV Mannitol (1.0 g/kg mo te 30-45 min); Whakahauhia te Kai Ape i nga Marama E ono Marama"]
    E -->|"Poauau, Pokarekare, Pupuu, Ngaro Mahara Waa Poto"| I["WHAKAPAIHA MAHI (Acid Domoic): ICU Airway Protection + IV Benzodiazepines/Phenobarbital for Status Epilepticus"]
    E -->|"Allodynia Matao + Tingling Wāhanga + Bronchospasm (KORE Paralysis)"| J["NEUROTOXIC SHELLFISH POISONING (Brevetoxin - Tide Whero): Tautoko IV Wai + Albuterol mo Bronchospasm"]
    E -->|"Te Pikitia Tere Te Mata/Te Waeme Nga Waahi + Te Paralysis Diaphragmatic"| K["WHAKAPAIHANA MAHI PARALITIKA (Saxitoxin): Whakanuia tonu i te Endotracheal Intubation me te Whakahau Miihini"]

Te whakataurite matawhānui o nga mate biotoxin e 4 o te moana¶

Syndrome 1: Ciguatera Fish Poisoning (CFP): Pathophysiology, Mannitol Protocol, me te Kai 6-Marama¶

Ko Ciguatera Fish Poisoning ko te mate paitini kaimoana kore huakita i te ao, e pa ana 50,000 to 500,000 tangata ia tau puta noa i nga rohe o te whitiki i waenga i nga ahopae 35 degrees North a 35 degrees South (te Karipiana, South Florida, Te Moana-a-Kiwa o Mexico, Hawaii, Poronīhia Wīwī, Te Moana-nui-a-Kiwa o Ahitereiria, Te Moana-nui-a-Kiwa ki te Tonga, me te Moana Inia). Na te mea ka tukuna e nga waka rererangi o te ao nga ika hou o te toka huri noa i te ao, he maha nga pakarutanga o Ciguatera ka puta ki nga ruma ohorere i New York, Ranana, Toronto, Paris, me Tokyo. (Gulf of Mexico)

1. Te Whakakoranga-Koiora o te Kai-Chain: He aha nga Kaikonihi Reef Rahi te Tino Morearea¶

• Ina pakaru nga toka i te awha, i te whakangao, i te keri, i te rerenga takutai ranei, ka noho nga mata o te wao mate e nga dinoflagellate benthic moroiti o te puninga Gambierdiscus (G. toxicus, G. polynesiensis).
• Ka kai nga ika iti o te ākau herbivorous i te macroalgae e kapi ana i te wheo me te kai gambiertoxins. I te mea ka kainga nga ika iti e nga ika kaikiko reo, me nga ika reo ka kainga e nga ** kaitukino o te toka (barracuda, grouper nui, tamu whero, amberjack, kingfish, moray tuna)**, ka waikurahia nga paitini-wairewa lipid e nga enzyme ate ika hei ciguatoxins (P-CTX-1, C-CTX-1, I-CTX) me te whakanui ake i te mekameka kai.
• No te mea he kino te ciguatoxin ki te ika ano, a 10-kilogram (22-pound) Barracuda or grouper he ahua hauora i te wa e mau ana i te horopeta whakamate tangata i roto i ona kikokiko me ona whekau.

2. Pathophysiology: He aha te wai makariri ka rite ki te ahi ka wera (Cold Allodynia)¶

+-------------------------------------------------------------------------+
|     MECHANISM OF CIGUATOXIN COLD ALLODYNIA & MANNITOL RESCUE            |
+-------------------------------------------------------------------------+
|  1. Ciguatoxin (CTX) binds Site 5 on Voltage-Gated Sodium Channels      |
|     (Nav1.6 / Nav1.8) in peripheral C-polymodal nociceptors & A-delta   |
|     cold-sensing nerve fibers                                           |
|  2. Shifts activation voltage to resting potential -> Spontaneous,      |
|     repetitive nerve depolarization whenever skin cools below 24-26 C   |
|     -> Brain interprets cold input as intense BURNING HEAT (Allodynia)  |
|  3. Continuous Na+ influx draws water osmotically into axons and        |
|     myelinating Schwann cells -> Acute Paranodal Schwann Cell Edema     |
+-------------------------------------------------------------------------+
|  HOW INTRAVENOUS 20% MANNITOL (1.0 g/kg) REVERSES ACUTE CIGUATERA:      |
|  * Creates an intravascular osmotic gradient that pulls trapped water   |
|    OUT of swollen Schwann cells and nerve axons at the nodes of Ranvier |
|  * Competitively displaces Ciguatoxin from sodium channel membranes     |
|    and scavenges free hydroxyl radicals generated by nerve ischemia     |
+-------------------------------------------------------------------------+

3. Ko nga punaha haumanu e 3 kua pangia e Ciguatera¶

1. Wāhanga Gastrointestinal (Onset 2 to 12 hours, mau tonu 24 to 48 hours): Te mate korere wai, te nausea, te ruaki, te werawera nui, me te kookiri o te puku.
2. Wāhanga Autonomic Cardiovascular (Onset 2 to 24 hours, mau tonu 2 to 5 days): Ko te Ciguatoxin e whakaihiihi ana i nga uaua o te ngakau me nga hongere konutai motuhake, ka puta te sinus bradycardia e whakamate ana i te ora (heart rate 30 to 45 bpm), paraka ngakau AV, me te whakaheke toto (systolic BP < 70 to 80 mmHg).
3. Pathognomonic Neurological Phase (Onset 3 to 72 hours, mau tonu weeks to months):
4. Circumoral and Acral Paresthesia: Te tino matemate me te oho i te ngutu, te arero, te korokoro, te maihao, me nga matimati.
5. ** Allodynia makariri (Hot-Cold Temperature Reversal):** I kitea i roto 70% to 90% o nga keehi. Ma te pa atu ki te poti kuaha makariri, ka eke ki runga i te papa taera hauhautanga, te inu wai matao ranei ka pa te wera, te wera, te mamae hiko ranei.
6. Niho Kore (Odontalgia): He rongo matarohia kei te matara nga niho i roto i o ratou turanga** kei te mamae mamae ranei ina ngau ana.
7. Pruritus ("La Gratte"): Te patito whanui puta noa i nga nikau, kapu, me te katua e kino haere ana i te po, me te ngenge o te ngenge (asthenia), myalgias, arthralgias, dysuria, me te dyspareunia.

4. Te Kawa Hospital-i-Step: Wai, Atropine, me te Intravenous 20% Mannitol¶

1. Taahiraa 1: Whakatikahia te matewai me te Bradycardia TUATAHI (Mandatory Pre-Mannitol Stabilization):
2. Whakawhao 1 to 2 liters o 0.9% te tote noa, te lactated Ringer's ranei kia tere te whakaputa mimi (> 0.5 to 1.0 mL/kg/hour) me nga kiriuhi mucous he makuku.
3. Mo te bradycardia tohumate (HR < 50 bpm) te whakaheke toto ranei, tukuna Atropine Intravenous (0.5 to 1.0 mg IV pana ia 5 minutes, tae noa ki 3 mg) me te taapiri i te horopeta iti dopamine ranei norepinephrine whaowhia mena ka mau tonu te whakaheke toto i muri i te whakakiinga o te wai.
4. Taahiraa 2: Te whaowhia Mannitol 20% Intravenous (Within 48 to 72 Hours of Ingestion):
5. He aha te take o te wa me te whakamakuku: Ka tino whai hua te mannitol i roto i te toto ina hoatu i roto i te tuatahi 24 to 48 hours (up to 72 hours) o te timatanga o nga tohu. KAUA KAUA e whaohuia te mannitol ki roto i te turoro kua mate wai, i te mate hypotensive ranei, na te mea ko te diuresis osmotic ka paheke te wiri hypovolemic nui me te necrosis tubular acute.
6. Kawa Tota Tote Tika: Ina he euvolemic te manawanui me te normotensive, whakawhia 1.0 gram per kilogram (1.0 g/kg, ranei 5 mL/kg o a 20% Te otinga Mannitol) i runga i te toto 30 to 45 minutes.
7. Tuaruatia te Tota: Mena ka peehia te whakamaarama neurosensory e te hokinga o te wahanga o te ra i muri mai, he tuarua 1.0 g/kg horopeta o 20% Ka taea te hoatu mannitol 12 to 24 hours i muri mai me te whakakapinga crystalloid tiaki.
8. Taahiraa 3: Te Whakaoranga Tohu mo te Neuropathy Turoro/Maamaa (Weeks 1 to 12):
9. Mena he nui ake te korero a te turoro 72 hours i muri i te kai, tohua te waha Gabapentin (300 to 600 mg e toru nga wa ia ra), Pregabalin (75 to 150 mg e rua nga wa ia ra), Amitriptyline ranei (25 to 50 mg i te wa e moe ai) hei whakaora i te allodynia makariri me te pruritus.

5. Ko te Mandatory 6-Marama Ciguatera Trigger-Avoidance Diet¶

Na te mea kei te noho tonu te ciguatoxin lipophilic ki roto i nga kiriuhi nerve peripheral me te kiko adipose mo nga marama, ko nga kai me nga inu e whakanui ana i te rere o te toto kiri, te tuku histamine, te whakarereke ranei i nga lipid membrane nerve ka ka hoki ano te mate o te kiri o te Ciguatera kua pupuhi katoa, te parastesia wera, me te ngenge ara. 3 to 6 months i muri i te rongonga o te manawanui kua ora. Ko nga turoro Ciguatera me tino karo i nga mea e whai ake nei mo 3 to 6 months: * Ko nga ika katoa, nga maataitai, me nga kaimoana (ara te taraute wai-maori-matao, te paramu kua whakatipuria, te tuna kēne ranei he kore ciguatoxin, ko te kai i nga pūmua ika ka hoki mai ano nga tohu). * Ko nga inu waipiro KATOA (te pia, te waina, te wairua, te waipiro ko te keu kotahi te tino kaha o te hokinga mai o te Ciguatera me te mate hypotension/bradycardia). * Nati, pīnati, hinu kākano (tae atu ki te pata pīnati, te aramona, te wōnati, me te hāmana). * Kafeine me nga kai histamine nui (kawhe, inu kaha, tiakarete pouri, me nga kai kua rongoatia).

Syndrome 2: Scombroid (Histamine) Paihana Ika: Te Anaphylaxis Mimic¶

Ka paihana ika Scombroid (histamine fish poisoning) he matū tino haurangi, ehara i te mate mate ika mo te roanga o te ora, na te kai i nga ika i pa ki te whakakino i te wa-mahana (stored above 4.4 degrees Celsius [40 degrees Fahrenheit] for more than 3 to 4 hours) i waenga i te hopu me te tunu kai.

Pathophysiology: Bacterial Histidine Decarboxylase¶

Ko nga ika pelagic kikokiko pouri mai i nga whanau Scombridae (tuna, mackerel, bonito, skipjack, albacore) me Scombresocidae, me nga momo kore-scombroid (mahi-mahi / dorado [Coryphaena hippurus], bluefish, amberjack, marlin, swordfish, escolar, sardines, anchovies, and herring), he tino tiketike rawa te nui o te waikawa amino kore utu L-histidine (> 1,000 mg/100 g) i roto i o ratou kiko uaua. * Mena ka waihohia te ika ki runga i te rahoraho poti mahana, ka whakamarokehia ki runga i te kaute wharekai, ka rongoa ranei ki roto i te pouaka whakamahana mahana, ka nui haere nga huakita karamu-kino ki runga i te hau me te puku (Morganella morganii, Klebsiella pneumoniae, Hafnia alvei, Photobacterium phosphoreum) ka tini ka whakaputa i te enzyme histidine. * I roto i nga haora, ka huri te histidine decarboxylase i te uaua L-histidine ki roto i nga kohinga nui o histamine (often > 50 to 500 milligrams per 100 grams o ika; he ika hou noa < 1 mg/100 g), i te taha o te biogenic diamines (putrescine me cadaverine) e aukati ana i nga mate histaminases intestinal tangata (diamine oxidase [DAO] a histamine N-methyltransferase) me te kaha ki te whakauru i te histamine nui ki roto i te toto. * Ahakoa ka whakatiohia e te wharekai te ika i muri mai ka wera, ka kohuatia ranei i te wera nui, **ka mate te huakita, engari ka noho tonu te histamine i mua i te hanga i te 100%.

+-------------------------------------------------------------------------+
|       SCOMBROID POISONING vs. TRUE IgE SEAFOOD ALLERGY TRIAGE           |
+-------------------------------------------------------------------------+
|  SCOMBROID (HISTAMINE) POISONING:                                       |
|  * Fish had a "peppery," "metallic," or "fizzy" bite on the tongue      |
|  * Multiple diners at the same table eating the tuna/mahi get sick      |
|  * Bright red "sunburn" flush on face, neck, and upper chest (often     |
|    WITHOUT raised wheals/hives) + throbbing histamine headache          |
|  * Patient has eaten the exact same fish species safely in the past     |
|    and CAN safely eat properly refrigerated fish again in the future    |
+-------------------------------------------------------------------------+
|  TRUE IgE-MEDIATED SEAFOOD ALLERGY (ANAPHYLAXIS):                       |
|  * Only the allergic individual reacts; other diners are unaffected     |
|  * Prominent raised pruritic urticaria (hives), angioedema of lips/     |
|    tongue, laryngeal stridor, and hypotensive anaphylactic shock        |
|  * Requires lifelong fish avoidance and an Epinephrine Auto-Injector    |
+-------------------------------------------------------------------------+

Hipanga-i-Step Scombroid Treatment Protocol¶

1. Tuarua H1 + H2 Antihistamine Blockade (The Definitive Cure):
2. Whakahaerehia he H1 kaiwhakawhanake antagonist: Diphenhydramine (Benadryl, 25 to 50 mg IV, waha ranei; 1 mg/kg i roto i nga tamariki) he aukati H1 whakatipuranga tuarua-kore ranei (Cetirizine 10 mg IV/PO).
3. Tukuna i te wa kotahi te H2 kaitukino kairiri: Famotidine (Pepcid, 20 mg IV, waha ranei; 0.5 mg/kg i roto i nga tamariki) ranei Cimetidine (300 mg IV) / Ranitidine. Na te mea ko nga oko toto kiri me te myocardium e whakaatu ana i nga kaiwhakawhiwhi H1 me te H2 histamine, ma te whakakotahi i te aukati H1 me H2 ka whakatau i te rewharewha o te kanohi, te mamae o te upoko, te tachycardia, me te kookiri o te puku i roto 15 to 30 minutes.
4. Ahea e hoatu ai i te Epinephrine me te Bronchodilators: Ko te nuinga o nga keehi scombroid he aukati i a ia ano (resolving in 6 to 12 hours) a kaore e hiahiatia he epinephrine. Heoi, i nga turoro kei raro i te huango, i nga turoro kaumātua kei te mate pukupuku korokoro, i nga turoro e tango ana Isoniazid (INH) ranei Monoamine Oxidase Inhibitors (MAOIs) (e aukati ana i te pakarutanga o te histamine mutunga me te wiri scombroid fulminant), ka taea e te histamine o waho te whakaoho ** bronchospasm (wheezing)** ranei vasoplegic hypotension. Whakapaia albuterol (salbutamol, 2.5 to 5 mg), wai whakaroto, me epinephrine intramuscular (0.3 to 0.5 mg o 1 mg/mL [1:1,000] ki roto i te huha anterolateral) i te wa tonu mena he mate manawa, he whakaheke toto ranei.
5. Te Whakaakoranga Turoro i mua i te Puta: Whakahauhia te manawanui (me te tuhi marama ki roto i tana tūtohi hauora) kua pa ki a ia Scombroid (histamine) kai paihana na te ika kore i whakamataohia, ehara i te mate mate ika hou, kia kore ai e tapaina he mate mate ki te kaimoana me te waikano rereke.

Syndrome 3 & 4: Neurotoxins Maataitai: Amnesic (Domoic Acid) vs. Neurotoxic (Brevetoxin) vs. Paralytic (Saxitoxin)¶

1. Paihana Maataitai Amnesic (ASP: Domoic Acid)¶

• Pūtake me te Hangarau: I hangaia e nga diatoms moana o te puninga Pseudo-nitzschia i te taha o te Moana-nui-a-Kiwa ki te hauauru, California, Atlantic Canada (Prince Edward Island, i puta te pakarutanga tuatahi o te tangata i 1987), Europe, me Aotearoa. Ko Wakawa Domoic he taurite hanganga o waikawa kainic me te neurotransmitter excitatory L-glutamate. Ka herea me te tino hononga ki AMPA me te kainate glutamate receptors kua tino aro ki roto i nga rohe CA1 me CA3 o te hippocampus tangata me te amygdala, ka puta te konupūmā mau tonu (Ca2+) urunga me te necrosis excitotoxic neuronal.
• Akoranga Haumanu: I roto 15 minutes to 24 hours o te kai i te kuku poke, te heu pipi, te Dungeness crab viscera ranei, ka tupu te mate whakapairuaki, te ruaki, me te kopu puku. I roto 4 to 48 hours (ina koa ki nga pakeke pakeke, ki nga turoro ranei he mate whatukuhu roa, i te mea kua whakakorehia te waikawa domoic ki nga whatukuhu), ka pa te paitini neurological: pokarekare, koretake, mutism, ngaungau/grimacing automatisms, tahanga toto kore iu, myoclonus, refractory status epilepticus, me te koma. He maha nga wa ka pa te hunga ora ** te ngaronga mahara mo te wa poto mo te anterograde** (kaore e kaha ki te hanga mahara hou i muri i te kai, he rite ki te Korsakoff psychosis me te tangohanga hippocampal bilateral).
• Maimoatanga: Karekau he rongoa. Whakahaerehia moata ** waro whakahohe** (within 1 to 2 hours), kaitaua ** te whakamakuku i roto i te toto** ki te whakanui ake i te whakawātea whatukuhu o te waikawa domoic wairewa-wai, me nga agonists nui ** GABA-A (IV lorazepam, midazolam, phenobarbital, a propofol)** ki te pehi i te hippocampal excitotoxic status epilepticus (phenytoin is ineffective against domoic acid seizures).

2. Pahana Maataitai Neurotoxic (NSP: Brevetoxin)¶

• Pūtake me te Hangarau: I hangaia e te dinoflagellate kore patu Karenia brevis (formerly Gymnodinium breve), ko te rauropi te kawenga mo Florida me te Gulf of Mexico "Red Tides" (me nga puāwaitanga rite ki Aotearoa). Brevetoxins (PbTx) herea ki Pae 5 i runga i nga hongere konutai ngaohiko-kuti, he rite tonu te waahi whakawhiwhinga ki a Ciguatoxin.
• E Rua Nga Ara Whakaaturanga:
• Maataitai Awaha: Ko te kai i nga tio, pipi, coquinas kua pokea ka pa te ngutu, te arero, me te korokoro o roto. 30 minutes to 3 hours, ka whai i te ruaki, te matere, te mangere, te ataxia, ** Cold Allodynia (hot-cold temperature reversal)**, nga kohungahunga kua topa, me te bradycardia ngawari. Kaore i rite ki te Poisoning Shellfish Paralytic (Saxitoxin), KORE te NSP e pangia e te pararutiki manawa, ka ora katoa nga turoro i roto 2 to 3 days me nga wai IV tautoko.
• Te Ngaru Aerosol Inhalation ("Mare o te Tai Whero"): Na te mea he marumaru nga pūtau Karenia brevis me te kore he anga maro, ko nga ngaru o te moana e tuku ana i nga pukohu me te whakarewa i te brevetoxin wairewa lipid ki roto i nga aerosol rehu moana. Ko nga tangata takutai me nga kainoho takutai e mau ana i te kohu ka whanake tonu (within 5 to 15 minutes) te wera o te kanohi, te rhinorrhea, te mare hacking kore-hua, me te ** bronchospasm nui** i roto i nga tangata whai huango, COPD ranei. Te neke ki roto i te whare ki tetahi whare hau-a-rangi me te tuku i nga agonist beta-2 kua mauhia (albuterol) ka whakatau tere i nga tohu.

Nga kawa ohotata a-rohe me nga kawa purongo moana¶

• Te Hononga o Amerika me Kanata: Waea atu ki a 911 mo nga mate ohotata, ngakau, roroa ranei, ka whakapa atu ki te Mana Paihana (1-800-222-1222 i te US; 1-844-POISON-X i Kanata). I Florida, te Moana-a-Kiwa o Mexico, Puerto Rico, nga Moutere Wahine o Amerika me Hawaii, nga taonga o nga tari ohorere (Gulf of Mexico) 20% Mannitol mo te whaowhia Ciguatera tonu, me nga tari hauora o te kawanatanga ka tono toenga kai tio mo te FDA Center for Food Safety and Applied Nutrition (CFSAN) whakamātautau.
• United Kingdom and European Union: Waea 999 (UK) ranei 112 (EU). Ka toro atu nga tohunga haumanu ki te NPIS / TOXBASE (UK), ki nga pokapū paihana a-motu ranei o EU (CAPTV i Wīwī, e whakarite ana hoki i ngā rohe Wīwī i tāwāhi i te Karipiana [Guadeloupe, Martinique] me Te Moananui-a-Kiwa [French Polynesia, New Caledonia] kei reira a Ciguatera he hyper-endemic). I tua atu, ko te amberjack (Seriola) me te barracuda kei roto i nga Canary Islands, Madeira, me te taha rawhiti o Mediterranean ka puta nga pakarutanga o te Pakeha Ciguatera.
• Ahitereiria, Aotearoa, me nga Moutere o te Moana-nui-a-Kiwa: Waea mai ki a 000 (Ahitereiria) ranei 111 (Aotearoa), ka toro atu ki te Poisons Information Centre (13 11 26 i Ahitereiria; 0800 764 766 i Aotearoa). I Queensland, Te Taitokerau, Whītī, Hāmoa, Tonga, me Vanuatu, Ciguatera mai i te taraute kao, tawatawa Spanish, bass whero, me te ika hainamana he whakaaturanga haumanu nui e whakahaerehia ana me te IV crystalloids, atropine, me te moata. 20% manitol (1.0 g/kg).
• Ahia (Hong Kong, Hapani, Philippines, Ahia ki te Tonga): Tauhokohoko kai-ika a te toka ora (grouper, humphead wrasse, snapper) he maha nga tautau Ciguatera puta noa i Hong Kong, ki te tonga o Haina, me te tonga-tonga o Ahia; Ko nga pokapū paitini a-rohe e whakamana ana i te 48-to-72-hour Ko te matapihi IV mannitol me te tino karo 6-marama i te ika, te waipiro, me te nati.

Pātai auau¶

He aha te "cold allodynia" (he wera me te makariri) he paihana kaimoana te take?¶

Ko te allodynia makariri (e kiia ana ko te hurihanga wera-makariri) he tohu neurological pathognomonic e pa ana ki te wai matao, ki te pupuri i te inu tio, ki te eke ranei ki runga i te papa hauhautanga ka puta te mamae mamae, te wera, te ru hiko ranei ki te kiri me te korokoro. Ka puta na te mea ka tutakina e Ciguatoxin (mai i nga ika akau puihi penei i te barracuda, grouper, me te tamure) me te Brevetoxin (mai i te maataitai tai whero) e tuwhera ana i nga hongere konutai ngaohiko-kuti i roto i nga muka nerve peripheral e rongo ana i te makariri, ka kaha te ahi ina whakamatao i raro i te 24 ki te 26 nga nekehanga Celsius.

He aha te take me whiwhi wai tote ki te tuuroro i mua i te whiwhi IV Mannitol mo Ciguatera?¶

Ko te Intravenous 20% Mannitol (1.0 g/kg i roto i te 30 ki te 45 meneti i roto i te 48 ki te 72 haora) ka mahi ma te tango i te wai taikaha i roto i nga pūtau Schwann tetere e karapoti ana i nga nerves peripheral kawa, ka tere te whakaora i te mate o Ciguatera me te mamae. Heoi, na te mea ka timata a Ciguatera me te ruaki nui, te matere wai, me te toto toto iti o te vagal, a ko te mannitol he diuretic osmotic kaha e kumea ana te wai ki roto i te mimi, ka hoatu he mannitol i mua i te whakamahanatanga o te manawanui ki te 1 ki te 2 rita o te tote noa ka puta te ohorere hypovolemic me te kino o te whatukuhu.

He aha te take e kore ai e taea e te tangata te ora mai i Ciguatera te inu waipiro, te kai ranei i tetahi ika, nati ranei mo te ono marama?¶

Ko te Ciguatoxin he tino ngako-wairewa, ka noho herea ki nga kiriuhi nerve peripheral me te ngako tinana mo nga marama i muri i te otinga o te gastroenteritis tuatahi. Ko te inu waipiro, ahakoa momo ika, maataitai ranei (ahakoa te ika wai maaori, he paramanawa kēne ranei), te pīnati, te nati rakau, te kawhe, te tiakarete ranei i roto i te 3 ki te 6 marama ka puta ohorere te hokinga mai o te mamae o te nerve, te werawera, te whakaheke toto, me te tino ngenge.

Me pehea e mohio ai koe he paihana te ika Scombroid i tua atu i te mate mate mate kaimoana mo te ao katoa?¶

Ko te paihana o Scombroid me te tauhohenga mate mate ka puta te paheketanga o te kanohi, te hiwi, te papouri, me te wheehe i roto i te 10 ki te 60 meneti i muri i te kai ika, ka whakautu nga mea e rua ki nga antihistamines (me te epinephrine mena he kino). Heoi, ka puta mai a Scombroid i te kai i nga ika kai pouri (tuna, mahi-mahi, mackerel, bluefish) karekau i whakamatao, ka taea e te huakita te huri i te histidine uaua ki roto i te histamine: he maha nga wa ka reka te ika ki te papura, he konganuku ranei, he maha nga tangata i tiri i te rihi ka mate tahi, karekau he mate mate mate IgE pono o te turoro, a ka taea te kai ika hou a muri ake nei.

He aha te take e tango ana nga turoro i te Isoniazid (INH) mo te mate kohi i te tino mate mai i te ika Scombroid?¶

Ko te Isoniazid (INH) me te monoamine oxidase inhibitors (MAOIs) ka kaha te aukati i te diamine oxidase (DAO, te histaminase ranei), te enzyme taiao i roto i te pakitara whekau tangata e pakaru ana i te histamine kai i mua i te urunga ki roto i te toto. Mēnā ka kai te tūroro e kai ana i te isoniazid i te tuna, te mahi-mahi, te tawatawa ranei he iti noa te taumata o te histamine, ka waipuketia te histamine kore-metabolized i te tohanga o te punaha, ka pupuhi te pupuhi, te mamae o te upoko, te bronchospasm nui, me te wiri hypotensive.

Ma te whakamaroke i te ika me te whakamau ki te wai kotakota mo te ceviche ka mate a Ciguatera, Scombroid paitini ranei?¶

Kao, karekau te Ciguatoxin, Scombroid histamine, me te maataitai koiora (Wakawa Domoic, Brevetoxin, Saxitoxin) e whakangaromia ma te tio, te koropu, te parai, te tunu, te kai paipa, te wai whakakoi waiwaona waikawa ranei. Ahakoa te whakamatao i te tuna hou, te mahi-mahi ranei i runga i te hukapapa i raro iho i te 4.4 nga nekehanga Celsius (40 nga nekehanga Fahrenheit) mai i te wa e mau ana, ka kore e taea e te huakita te hanga histamine hou, ina uru ana te histamine me te ciguatoxin ki roto i te awhi, karekau he tikanga tunu e taea te haumaru.

Ki te whakarite mo te kai, mate mate, me te haerenga ohorere hauora, whakaaro ki te tango i te awhina tuatahi me te akoranga CPR mai i te Red Cross, St John Ambulance, tetahi kaiwhakarato whakangungu rohe ranei.

Nga kaiarahi e pa ana¶

• Botulism, Ciguatera, Scombroid, me te Maataitai Neurotoxin Poisoning Overview
• Nga Tauhohenga Pawera me te Awhina Tuatahi Anaphylaxis
• Rebound Anaphylaxis, Biphasic Allergic Reaction, and Second EpiPen Time
• Poisoning Kai, Acute Gastroenteritis, me te mate wai
• Paihana Whanui Awhina Tuatahi me te Whakamate

Nga puna me nga aratohu whai mana¶

• U.S. Nga Pokapū mo te Manaakitanga me te Aukati i te mate (CDC): Puka Kowhai CDC (He Moohiohio Hauora mo te Haerenga o te Ao): Paihana Kai mai i nga Toxins Moana (Ciguatera, Scombroid, me te Paihana Shellfish) (Te Hononga o Amerika).
• U.S. Whakahaere Kai me te Taakaro (FDA): Buka Bug Kino (Nga Microorganisms Pathogenic Kai me te Toxins Natural, 2^nd Edition): Scombrotoxin (Histamine), Ciguatoxin, Domoic Acid (ASP), Brevetoxin (NSP), me Saxitoxin (PSP) (United States).
• World Health Organization (WHO) & Food and Agriculture Organization (FAO): Ripoata o te Hui Tohunga mo te Paihana Ciguatera me nga Biotoxins moana i Bivalve Molluscs (Rome / Geneva).
• ** UK National Poisons Information Service (NPIS) / TOXBASE:** Whakahaere Haumanu o Ciguatera Fish Poisoning (Mannitol Protocol), Scombroid Fish Poisoning, me Shellfish Neurotoxins (United Kingdom).
• Friedman MA, Fleming LE, Fernandez M, Bienfang P, et al.: Te paihana ika Ciguatera: te maimoatanga, te aukati me te whakahaeretanga (Marine Drugs / Palafox NA intravenous mannitol studies).