Ko e kona 'o e ika 'o e Ciguatera (Fakafetongi 'o e mafana 'o e vela-mokomoko, Bradycardia) vs.¶

Ko hono fakatupulaki ‘o e tingling fakafokifā ‘i he tafa‘aki ‘o e ngutú, vela ‘a e kilí ‘i he taimi ‘oku ala ai ki he vai momokó, ko ha fofonga kulokula ngingila, pōlepole, pe faingata‘a‘ia ‘i he mānava ‘i he hili pē ‘a e kai ‘a e ika ‘o e ‘aá, pelagic steaks, pe bivalve shellfish ‘oku fiema‘u ki ai ha fakafaikehekehe‘i fakafaito‘o vave ‘i he lotolotonga ‘o e ngaahi biotoxins lalahi ‘o e tahí. Ta ki hoʻo fika fakavavevave fakalotofonuá (911 ʻi he ʻIunaiteti Siteití mo Kānata, 112 ʻi he kotoa ʻo e ʻIunioni ʻIulopé, 999 ʻi he Puleʻanga Fakatahatahá) pe vakai ki heʻemau . tohi fakahinohino fika fakavavevave fakavaha'apule'anga ‘i he taimi pē ko iá kapau ‘oku fakahaa‘i ‘e he tokotaha kai ‘a e tō māmālie ‘a e mafú, ma‘ulalo ‘a e toto mā‘olungá, ngingila, puputu‘u, pe vaivai ‘a e uouá. Koe'uhi Ko e kona 'o e ika Scombroid 'oku ne fa'ifa'itaki ofi ki ha IgE-mediated 'oku 'ikai ke 'i ai ha 'uhinga . tali 'a e sinó pe 'anafilakisi, lolotonga ia 'oku fakakakato 'e he Ciguatera, 'Esiti Domoic, mo e Brevetoxin 'etau ngaahi me'a 'oku lahi ange . botulism mo e fakahinohino ki he neurotoxin 'o e ika 'o e 'anga'anga 'oku palalisia, kuo pau ke toe fakafaikehekehe‘i ‘e he kau talí ‘a e ngaahi kona ko eni ‘oku tu‘uma‘u ‘i he velá mei he pekitilia . kona ‘o e me‘akaí mo e mahaki faka‘auha ‘o e mafú ..

Ko hono tunu, fakavela, tunu, ta'o, ifi, faka'aisi, pe faka'ai'ai 'a e ika 'i he vai 'o e laime (ceviche) 'oku 'IKAI ke ne faka'auha ha taha 'o e ngaahi kona 'o e tahi ko 'eni. Tānaki atu ki aí, ko e ika mo e ika kona ‘oku nau hā, nanamu, mo ifo ‘aupito (tukukehe pē ha ‘u‘u pepa pe ukamea ‘i he taimi ‘e ni‘ihi ‘i he ika scombroid). Kuo pau ke fakafaikehekeheʻi vave ʻe he kau toketā fakavavevavé mo e kau fonongá ʻa e ngaahi mahaki lalahi ʻe fā ʻo e tahí: 1. Kona 'o e Ika Sikuatela (CFP): Tupu mei he kai ‘o e fanga ika lalahi ‘o e ‘aá (barracuda, kulupu, snapper kulokula, amberjack, moray eel, hogfish, mackerel Sipeini, talausi ‘o e ‘aá) ‘oku ‘i ai ‘a e ciguatoxins (CTX) bioaccumulated mei he ngaahi me'amo'ui 'i he lalofonua Gambierdiscus toxicus. 'Oku 'i ai 'a e gastroenteritis 'oku 'ikai ke fu'u lahi (2 to 12 hours), fakatu‘utāmaki ki he mo‘uí sinus bradycardia mo e ma‘ulalo ‘a e toto, mo e pathognomonic allodynia momoko (hot-cold temperature reversal), faito'o 'i loto 'i he . 48 to 72 hours mo e 20% Manitoli (1.0 g/kg) pea mo e me'akai faka'ehi'ehi mei he trigger-mahina 'e 6 fefeka. 2. Sikomipoloiti (Histamine) Fakakonahi ‘o e Ika: ‘Oku tupu ia mei he kai ‘o e ika kakano’i manu ‘uli’uli ‘oku ‘ikai ke fakamokomoko totonu (tuna, mahi-mahi [dorado], ika lanu pulu, maka, bonito, mālini, satini, ‘anisi) ‘a ia ‘oku liliu ai ‘e he fanga ki’i pekitilia ‘i he funga ‘o e funga ‘o e uoua L-histidine ‘a e lahi ‘o e histidine. 'Oku 'oatu 'i loto 'i he 10 to 60 minutes ko ha fakaofo "hange ko e vela 'a e la'a" histamine flush, mamahi 'ulu 'oku tetetete, 'oku 'oho 'a e mafu, mo e bronchospasm, faito'o vave 'aki 'a e H1 mo e H2 antihistamines (not permanent fish allergy). 3. Ko e Fakakonahi 'o e Ika 'o e 'Amnesic (ASP - Domoic Acid): Fakatupu 'e he Pseudo-nitzschia 'a e ngaahi matala'i'akau 'o e taiatomi 'i he musie, fanga ki'i 'uhiki'i 'uhiki'i manupuna, fanga ki'i 'uhiki'i manupuna, mo e ngaahi 'uhiki'i manupuna 'o e Dungeness; 'oku ne fakatupu 'a e tu'unga 'o e epilepticus mo e ** mole 'a e manatu taimi nounou 'o e anterograde tu'uma'u **. 4. Kona 'o e Ika 'o e Neurotoxic (NSP - Brevetoxin): Fakatupu 'e he Karenia brevis ("Fololita / 'o e 'Otu Mekisikou 'o e peau kulokula") 'o e fanga ki'i 'ositā mo e fanga ki'i kalami; 'oku ne faka'aonga'i 'a e ngaahi halanga sotiume 'oku 'i ai 'a e voliume (hange pe ko e ciguatoxin) ke fakatupu 'a e ** allodynia momoko **, paresthesia, mo e bronchospasm 'o e matātahi 'oku 'ikai ha palalisia. (Gulf of Mexico)

+-------------------------------------------------------------------------+
|            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  |
+-------------------------------------------------------------------------+

Fai ʻeni he taimí ni .¶

1. Sivi’i vave ‘a e mānava, tu’unga ‘o e mafú, mo e toto mā’olungá, pea tā ki he ngaahi ngāue fakavavevavé. Taila ki he 911 (‘Amelika mo Kānata), 112 (‘Iunioni ‘Iulope), 999 (Pule‘anga Fakatahataha), 000 (‘Aositelēlia), pe 111 (Nu‘u Sila).
2. Kapau na'e kai 'e he tokotaha tuna pe mahi-mahi . 15 minutes ‘i he kuohilí pea ‘i he taimí ni ‘oku ‘i ai ‘ene ngingila, ngingila ‘a e kongalotó, pe fula ‘a e ‘eleló (Scombroid lahi), ‘oange ha ‘epinephrine ‘otomētiki ‘o e huhu (EpiPen) ki he hui ‘i tu‘á kapau ‘oku ma‘u, pea ‘oange ‘a e diphenhydramine (Benadryl, 25 to 50 mg) pe setilisini (10 mg) mo e famotitini (Pepcid, 20 mg) kapau te nau lava ʻo folo malu.
3. Kapau naʻe kai ʻe he tokotahá palakuta, kulupu, snapa kulokula, pe ʻēmipa 2 to 8 hours kuohili pea ongo'i 'oku 'ikai ke 'i ai ha 'uto pe 'oku 'ikai ke ne lava 'o 'ilo'i 'aki ha pulse tuai (below 50 beats per minute) (Ciguatera), fakatokoto kinautolu ʻi honau tuʻá ʻo hiki hake honau vaʻé . 30 centimeters (12 inches) ke tauhi 'a e tafe 'a e toto ki he 'uto lolotonga 'a e tatali ki he kau toketaa 'aki 'a e atropine 'i he veini mo e saline angamaheni.
4. Fakahoko 'a e "Sivi 'o e Me'a Momoko" 'i he tafa'aki mohenga ki he Ciguatera pe Brevetoxin. 'Ai ke ala 'a e mahaki ki ha hina sota momoko, ha 'aisi, pe ko ha vai momoko 'o e paipa. Kapau 'oku ongo 'a e me'a momoko 'o hange ko e mamahi 'a e afi vela, 'aisi momoko, pe ngaahi 'uhila (cold allodynia / hot-cold temperature reversal), ko e faka'ilonga 'oku meimei pau ko e Kona 'o e Ika Ciguatera (kapau na'e kai 'a e ika 'o e 'aá) pe Kona 'o e ika 'o e 'aá) Neurotoxic (Brevetoxin) (kapau na'e kai 'a e ika 'o e Gulf 'o Mekisikou / subtropical). (Gulf of Mexico)
5. 'Oua 'aupito na'a ke inu vai 'aisi pe kaukau momoko kapau 'oku mahalo'i 'oku 'i ai ha Ciguatera. Ko e inu 'o e ngaahi me'a momoko 'oku ne fakatupu 'a e mamahi vela lahi 'i lalo 'i he ngutu mo e esophagus, pea ko e vai momoko 'i he kili 'oku ne fakatupu 'a e paresthesia mamahi. Tuku atu pe loki-mafana pe vai mafana rehydration ngutu 'i he fanga ki'i sips.
6. Fakapau'i 'oku fakafoki kakato 'a e vai 'i he veini KIMU'A pea toki 'oange 'a e Mannitol ki he veini ki he Ciguatera. Talaange ki he toketā fakavavevave 'oku ma'u 'e he mahaki 'a e Ciguatera Fish Poisoning 'i loto 'i he 48 to 72 hour matapa sio'ata ki he Mannitol 20% 'i he veini (1.0 gram/kg). Kaekehe, koe'uhi ko e mannitol ko ha diuretic osmotic malohi pea 'oku fakatupu 'e he Ciguatera 'a e vave 'o e lua lahi mo e 'uto, kuo pau ke TOKI fakahu 'a e mannitol hili hono fakatonutonu kakato 'o e hypovolemia mo e 'ikai ha vai 'i he . 1 to 2 liters 'o e ngaahi sio'ata 'oku 'i he veini 'o e isotropic (0.9% saline angamaheni pe ko e Ringer 'o e Laktate).
7. Tauhi mo faka'aisi 'a e toenga ika pe ika 'o e 'anga'anga pea fakatokanga ki he kau kai kehe kotoa pe. Takai'i ha toenga 'o e me'akai 'oku te'eki ke tunu pe tunu 'i ha foil pe ko ha kato pelesitiki pea faka'aisi ia ki he sivi 'o e biotoxin 'a e potungaue mo'ui (FDA / state marine lab liquid chromatography-mass spectrometry). Fetu'utaki leva ki he tokotaha kotoa pe na'a ne vahevahe 'a e ika.

'Akau 'o e tu'utu'uni: Ika 'o e tahi mo e ika 'o e 'anga'anga 'o e triage¶

flowchart TD
    A["Mahaki Fakatu'utamaki Hili Hono Kai Ika 'o e Tahi pe Ika 'o e 'Alu"] --> B{"Ko e hā e Faʻahinga Meʻakai Tahi Naʻe Kaí?"}
    B -->|"Ika Pelakiki Kakano-Uli'uli (Tuna, Mahi-Mahi, Makeleli, Ika Lanu Pulu, Satini)"| C{"Kamata 'i he 10-60 Min mo e Kulokula Ngingila 'o e Fofonga/Ki'i Flush & Tachycardia?"}
    B -->|"Ika Fakatalopiki/Suptalopiki 'o e 'A'ake (Palakuta, Kulupu, Snapper, 'Emipa, 'Eli)"| D{"Ko e mahaki 'o e kete (2-12h) + 'Alotinia momoko, Mamahi 'o e nifo, pe Bradycardia?"}
    B -->|"Ika 'o e Bivalve (Mussels, Clams, 'Osita, Scallops) pe ko e Viscera 'o e Pa'a"| E{"Fakafaikehekeheʻi ʻa e Syndrome ʻo e Ika ʻo e ʻAá ʻaki ʻa e Ngaahi Fakaʻilonga Neutolosia"}
    C -->|"ʻIo"| F["SCOMBROID (HISITAMINI) KONA 'O E IKA: 'Oange 'a e IV/PO H1 Poloka (Tifenihailamini 25-50 mg) + H2 Poloka (Famotitini 20 mg IV); Albuterol/Epi kapau 'oku 'u'ulu"]
    D -->|"ʻIo"| G["CIGUATERA IKA KONA (CFP): 'Uluaki Fakaakeake 'aki 'a e 1-2 L IV 0.9% Saline + IV 'Atolopini (0.5-1 mg) ki he Bradycardia/Ma'ulalo 'a e toto"]
    G --> H["'I he taimi 'e taha (pea 'i loto 'i he 48-72h): Fakahu 'a e 20% IV Mannitol (1.0 g/kilo 'i he 30-45 min); Fakamālohi'i 'a e 6-Mahina Trigger Faka'ehi'ehi mei he Me'akai"]
    E -->|"Puputu'u, Ta'e'ilo, Puke, Mole 'a e Manatu Taimi Nounou"| I["AMNESIC SHELLFISH KONA ('Esiti Domoic): Malu'i 'o e Halanga 'Ea 'o e ICU + IV Penisotiazepines/Phenobarbital ki he Tu'unga 'o e 'Epilepitika"]
    E -->|"Allodynia momoko + 'Ulu 'i he tafa'aki 'o e ngutu + 'Ulu 'o e mafu ('IKAI 'I AI ha palalisia)"| J["KONA 'O E 'ALU 'O E 'ALU (Brevetoxin - Tafe Kulokula): Poupou IV Vai + Albuterol ki he Bronchospasm"]
    E -->|"Vave 'a e 'alu hake 'a e fofonga/va'e 'o e fofonga + Diaphragmatic Palalisia"| K["KONA 'O E 'IKA 'O E 'ULU (Saxitoxin): Fakahu 'o e Endotracheal vave & Fakahu fakamisini 'o e 'ea"]

Fakafehoanaki kakato 'o e 4 syndromes 'o e biotoxin 'o e tahi .¶

Ko e Mahaki 1: Ko e Kona ‘o e Ika Siguatera (CFP): Patofisiolosia, Polokalama Mannitol, mo e Meʻakai ʻo e Māhina ʻe 6¶

Ko e kona ‘o e ika Ciguatera ko e mahaki kona ‘o e me‘akai tahi ‘oku ‘ikai ko ha pekitilia lahi taha ia ‘i he māmaní, ‘o uesia ai ‘a e 50,000 to 500,000 kakai fakata'u 'i he ngaahi vahenga 'o e fusi endemic 'i he vaha'a 'o e latitudes . 35 degrees North pea . 35 degrees South (ko e Kalipiané, Folōlita Tongá, Ko e Kōlomu ʻo Mekisikoú, Hauaiʻí, Polinisia Falaniseé, ʻOtu Motu Lahi ʻo ʻAositelēliá, Pasifiki Tongá, mo e ʻŌseni ʻInitiá). Koe‘uhi ‘oku fakafolau atu he taimí ni ‘e he ngaahi uta ‘ea fakavaha‘apule‘angá ‘a e ika fo‘ou ‘i he ‘aá ‘i māmani lahi, ‘oku fa‘a ‘asi mai ‘a e ngaahi mahaki ‘o e Ciguatera ki he ngaahi loki fakavavevave ‘i Niu ‘Ioke, Lonitoni, Tolonitō, Pālesi, mo Tōkiō. (Gulf of Mexico)

1. Bioaccumulation 'o e Food-Chain: Ko e hā 'oku fakatu'utamaki taha ai 'a e fanga manu kai 'o e 'aá lalahi¶

• Ko e taimi 'oku maumau'i ai 'a e ngaahi 'ao 'e he ngaahi matangi, fakahinehina, keli, pe tafe 'a e vai 'i he matātahi, 'oku hoko 'a e ngaahi funga 'o e 'ao mate 'o kolonia 'e he fanga ki'i 'akau 'o e 'ao 'o e fa'ahinga Gambierdiscus (G. toxicus, G. polynesiensis).
• Ko e fanga ki'i ika 'o e 'aá 'oku nau kai 'akau 'i he ngaahi macroalgae 'oku nau 'ufi'ufi 'a e 'aá pea 'oku nau kai 'a e gambiertoxins. Hange ko e fanga ki'i ika iiki 'oku kai ia 'e he ika kai kakano'i manu lolotonga, pea ko e ika lolotonga 'oku kai ia 'e he ngaahi manu fekai 'o e 'a'ake 'o e tumutumu (barracuda, kulupu lahi, snapper kulokula, amberjack, ika tu'i, moray eel), 'oku oxidized 'a e ngaahi kona 'oku lipid-soluble 'e he ika 'ate 'enisaimi insguato ki he fakatupu mateP-CTX-1, C-CTX-1, I-CTX) pea fakalahi hake 'a e seini me'akai.
• Koe‘uhi ‘oku ‘ikai ke fakatu‘utāmaki ‘a e ciguatoxin ki he iká tonu, ko ha . 10-kilogram (22-pound) barracuda pe grouper ‘oku hā mo‘ui lelei lolotonga ‘ene ‘ave ha faito‘o fakatupu mate ‘o e tangatá ‘i hono kakanó mo e ngaahi ‘ōkaní.

2. Pathophysiology: Ko e hā ʻoku ongoʻi ai ʻe he Vai Momokó ʻo hangē ha afi velá (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 e ngaahi sisitemi fakafaito'o 'e 3 'oku uesia 'e he Ciguatera .¶

1. Ko e konga 'o e kete (Onset 2 to 12 hours, tu‘uloa . 24 to 48 hours): Ko e 'u'ulu fakafokifā 'o e vai, 'u'ulu, 'u'ulu, 'u'ulu lahi, mo e 'u'ulu 'i he kete.
2. Ko e Vahe 'o e 'Otonomi 'o e Loto (Onset 2 to 24 hours, tu‘uloa . 2 to 5 days): 'Oku faka'ai'ai 'e he Ciguatoxin 'a e ngaahi filo vagal 'o e loto mo e ngaahi halanga sotiume 'otometiki, 'o fakatupu 'a e bradycardia sinus fakatu'utamaki ki he mo'ui (heart rate 30 to 45 bpm), poloka loto AV, mo e ma'ulalo lahi 'a e toto (systolic BP < 70 to 80 mmHg).
3. Ko e Vahe Fakaneutolosia Fakafaito'o (Onset 3 to 72 hours, tu‘uloa . weeks to months):
4. Circumoral mo e Acral Paresthesia: Ko e fu'u ngingila mo e ngingila 'i he tafa'aki 'o e loungutu, 'elelo, ngutu, ngaahi tumu'aki 'o e louhi'i nima, mo e louhi'i va'e.
5. Alotinia momoko (Hot-Cold Temperature Reversal): Sio ki he 2019. 70% to 90% ‘o e ngaahi keisi. Ko e ala ki ha fo‘i matapā momoko, laka ki ha faliki taila momoko, pe inu ha vai momoko ‘okú ne fakatupunga ha mamahi ‘oku vela, vela, pe ‘uhila.
6. Ko e Nifo 'o e Nifo (Odontalgia): Ko e ongo fakakalasi 'oku vetevete 'a e nifo 'i honau ngaahi sote pe mamahi mamahi 'i he taimi 'oku u'u hifo ai.
7. Pruritus ("La Gratte"): 'Oku lahi 'a e 'u'ulu fakalukufua 'i he tafa'aki 'o e ngaahi nima, 'a e va'e, mo e 'akau 'oku toe kovi ange 'i he po'uli, 'o 'alu fakataha mo e vaivai fakavaivai (asthenia), mamahi ‘i he hui, mamahi ‘i he hui, dysuria, mo e dyspareunia.

4. Sitepu-ki-he-Sitepu 'o e Falemahaki Polokalama: Vai, Atropine, mo e 20% Mannitol 'i he veini .¶

1. Sitepu 1: Fakatonutonu 'a e 'ikai ha vai mo e Bradycardia 'ULUAKI (Mandatory Pre-Mannitol Stabilization):
2. Fakahu 1 to 2 liters 'o e 0.9% saline angamaheni pe Lactated Ringer's 'i he veini kae 'oua kuo vave 'a e 'alu 'a e mimi (> 0.5 to 1.0 mL/kg/hour) mo e ngaahi me‘a ‘oku ‘i ai ‘a e mucous ‘oku momoko.
3. Mo e bradycardia faka‘ilonga (HR < 50 bpm) pe ko e ma'ulalo 'a e toto, 'oange 'a e Atropine 'i he veini (0.5 to 1.0 mg IV teke kotoa . 5 minutes, ʻo aʻu ki he 100. 3 mg) pea tānaki atu ha faitoʻo dopamine pe norepinephrine ʻoku maʻulalo kapau ʻoku kei ʻi ai pē ʻa e maʻulalo ʻo e toto hili hono fakafonu ʻo e vaí.
4. Sitepu 2: Fakahu 'o e 20% Mannitol 'i he veini (Within 48 to 72 Hours of Ingestion):
5. Ko e ha 'oku mahu'inga ai 'a e taimi mo e hydration: 'Oku ola lelei taha 'a e mannitol 'i he veini 'i he taimi 'oku 'oatu ai 'i loto 'i he 'uluaki 24 to 48 hours (up to 72 hours) 'o e kamata 'a e faka'ilonga. 'OUA 'E TEITEI fakahu 'a e mannitol ki ha taha 'oku 'ikai ke 'i ai ha vai pe 'oku 'ikai ke 'i ai ha'ane toto, he 'e fakatupu 'e he osmotic diuresis 'a e 'ohovale 'o e hypovolemic 'o e 'oho mo e necrosis 'o e tubular 'o e 'oho.
6. Founga Totonu 'o e Faito'o: Ko e taimi pe 'oku euvolemic ai 'a e mahaki mo e normotensive, infuse 1.0 gram per kilogram (1.0 g/kg, pe . 5 mL/kg 'o ha 20% Mannitol fakalelei'i) 'i he veini 'i he 30 to 45 minutes.
7. Toe Dosing: Kapau 'oku muimui 'a e fakanonga 'o e neurosensory 'i ha toe foki mai 'a e konga 'i he 'aho hono hoko, ko ha sekoni . 1.0 g/kg faito'o 'o e 20% 'e lava ke fakahoko 'a e mannitol . 12 to 24 hours kimui ange fakataha mo e fetongi 'o e crystalloid tokanga'i.
8. Sitepu 3: Fakanonga Faka'ilonga ki he Subacute/Neuropathy Tu'uloa (Weeks 1 to 12):
9. Kapau ‘oku ‘omai ‘e ha mahaki ‘o lahi ange ‘i he 100. 72 hours hili ‘a e kai, faito‘o ‘a e Gabapentin (300 to 600 mg tu'o tolu he 'aho), Pelikabalini (75 to 150 mg tu‘o ua he ‘aho), pe ‘Amitilipilini (25 to 50 mg 'i he taimi mohe) ke fakanonga 'a e allodynia momoko mo e 'uto.

5. Ko e fakamālohi'i 'o e 6-Mahina Ciguatera Trigger-faka'ehi'ehi mei he me'akai .¶

Koe'uhi 'oku kei sequestered 'a e lipophilic ciguatoxin 'i loto 'i he ngaahi 'atakai 'o e neave peripheral mo e tisiuu adipose 'i ha ngaahi mahina, me'akai mo e inu 'oku fakalahi 'a e tafe 'a e toto 'i he kili, tukuange 'a e histamine, pe liliu 'a e lipids 'o e 'atakai 'o e neave 'e **toe-fakatupu ha toe fakafoki fakamālohi 'o e fatihe burest mo e Ciguatera kakato. 3 to 6 months hili ‘a e ongo‘i ‘e he mahakí kuó ne toe fakaakeake. Kuo pau ke faka'ehi'ehi 'aupito 'a e mahaki Ciguatera kotoa pe mei he ngaahi me'a ko 'eni ki he 3 to 6 months: **Ko e ika kotoa pe, ika, mo e me'akai mei ta (na'a mo e ika 'o e vai moko 'o e vai ma'a, salmon ngoue, pe tuna 'i he hina 'oku 'ikai ha ciguatoxin, kai ha fa'ahinga polotini ika 'oku ne fakatupu 'a e toe hoko mai 'a e faka'ilonga 'i he taimi pe ko ia). **Ngaahi inu kavamalohi KOTOA** (pia,aine, laumalie, kavamalohi ko e me'a 'e taha 'oku ne fakatupu 'a e toe 'asi 'a e Ciguatera 'a e 'uto mo e hypotension/bradycardia lahi). **Nati, pīnati, mo e lolo tenga'i 'akau** (kau ai 'a e ta pīnati, 'alimoni, uolonati, mo e sesame). * Ngaahi me'akai 'oku lahi ai 'a e kafeini mo e histamine (kofi, inu ivi, sokoleti 'uli'uli, mo e kakano'i manu kuo fakamo'ui).

Ko e Mahaki 2: Sikomipoloiti (Histamine) Fakakonahi 'o e Ika: Ko e Anaphylaxis Mimic .¶

Ko e kona 'o e ika Scombroid (histamine fish poisoning) ko ha kona fakakemikale lahi, 'ikai ko ha allergy mo'oni 'o e ika 'i he mo'ui, 'oku tupu mei he kai 'o e ika na'e mamahi'ia 'i he ngauekovi'aki 'o e taimi-mafana (stored above 4.4 degrees Celsius [40 degrees Fahrenheit] for more than 3 to 4 hours) ʻi he vahaʻa ʻo e puké mo e kuká.

Patofisiolosia: Hisititini Decarboxylase 'o e pekitilia¶

Ko e ika kakanoʻi manu ʻuliʻuli mei he ngaahi fāmili Scombridae (tuna, makeleli, bonito, skipjack, albacore) mo e Scombresocidae, pea pehē ki he ngaahi faʻahinga ʻoku ʻikai ke ʻi ai ha scombroid (mahi-mahi / dorado [1].Coryphaena hippurus], ika lanu pulū, ika ‘ēmipa, ika mālini, ika heletā, ika ‘esikolá, ika sātiní, ika ‘anisi, mo e ika hēlingí), ‘oku fakanatula pē ‘a e ‘i ai ‘a e ngaahi tu‘unga mā‘olunga ‘aupito ‘o e ‘ēsiti ‘amino tau‘atāiná L-histidine (> 1,000 mg/100 g) ‘i honau tisiū uouá. * Kapau ‘oku tuku ‘a e iká ‘i ha funga vaka māfana, fakamokomoko ‘i ha laupapa ‘o e falekaí, pe tauhi ‘i ha fō māfana, ‘oku ‘i ai ‘a e fanga ki‘i pekitilia ‘oku ‘ikai ke nau ma‘u ‘a e kalami ‘i he ‘utó mo e ‘utó (Morganella morganii, Klebsiella pneumoniae, Hafnia alvei, Photobacteriumproduceumphospice) ko e tikāpokisilaisi. * 'I loto 'i ha ngaahi houa, 'oku liliu 'e he histidine decarboxylase 'a e uoua L-histidine ki he ngaahi me'a lahi 'o e ** histamine ** (often > 50 to 500 milligrams per 100 grams ‘o e iká; ika fo'ou angamaheni 'oku 'i ai . < 1 mg/100 g), ʻi he tafaʻaki ʻo e ngaahi meʻa fakatupu moʻuí (putrescine mo e kataverine) ʻoku nau taʻofi ʻa e ngaahi histaminase ʻo e ʻuto ʻo e tangatá (diamine oxidase [DAO] pea . histamine N-methyltransferase) pea fakamālohi‘i ‘a e lahi ‘o e histamine ke hū ki he totó. * Neongo kapau 'e faka'aisi 'e he falekai kimui ange 'a e ika fefeka pea sears pe boils ia 'i he vela lahi, 'oku mate 'a e pekitilia, ka 'oku kei 100% 'a e histamine kuo fa'u kimu'a 'oku kei 'i ai pe mo ngaue.

+-------------------------------------------------------------------------+
|       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    |
+-------------------------------------------------------------------------+

Sitepu-ki-sitepu Scombroid faito'o polokalama¶

1. Poloka 'o e H1 + H2 'o e 'Anitihisitamini (The Definitive Cure):
2. Fakahoko ha H1 talitali fakafepaki: Diphenhydramine (Benadryl, 25 to 50 mg IV pe ngutu; 1 mg/kg ‘i he fānaú) pe ko ha poloka H1 ‘o e to‘utangata hono ua ‘oku ‘ikai ke fakanonga (Cetirizine 10 mg IV/PO).
3. 'I he taimi tatau 'oku fakahoko ai ha H2 fakafepaki'i 'o e tali: Famotidine (Pepcid, 20 mg IV pe ngutu; 0.5 mg/kg ‘i he fānaú) pe Simetitini (300 mg IV) / Lanititini. Koe'uhi ko e ngaahi ipu toto 'o e kili mo e myocardium 'oku nau fakahaa'i fakatou'osi 'a e H1 mo e H2 histamine receptors, 'oku fakalelei'i 'e hono fakataha'i 'o ha H1 mo e H2 blocker 'a e fofonga 'o e fofonga, throbbing 'ulu mamahi, tachycardia, mo e 'uto 'o e kete 'oku fakaofo 'i loto 15 to 30 minutes.
4. Ko e taimi ke 'Oange ai 'a e 'Epinefilini mo e ngaahi faito'o fakalahi: Ko e lahi taha 'o e ngaahi keisi scombroid 'oku fakangatangata pe ia (resolving in 6 to 12 hours) pea ‘oku ‘ikai fiema‘u ki ai ‘a e ‘epinefiliní. Kae kehe, ‘i he kau mahaki ‘oku ‘i ai ‘enau mafu ‘i lalo, kau mahaki matu‘otu‘a ‘oku nau ma‘u ‘a e mahaki ‘o e ngaahi halanga totó, pe ko e kau mahaki ‘oku nau to‘o ‘a e Isoniazid (INH) pe Ngaahi Fakata'e'aonga'i 'o e Monoamine 'Okisiteisi (MAOIs) ('a ia 'oku ne ta'ofi 'a e movete 'o e histamine 'i loto pea fakatupu 'a e 'ohovale 'o e scombroid fulminant), 'e lava ke fakatupu 'e he histamine 'i tu'a 'a e bronchospasm lahi (wheezing) pe ma'ulalo 'a e toto 'o e vaso. Fakahoko 'a e nebulized 'aliputeloli (salbutamol, 2.5 to 5 mg), ngaahi vai ‘i he uoua, mo e ‘epinefilini ‘i he uoua (0.3 to 0.5 mg 'o e 1 mg/mL [1:1,000] ki he 'uhiki 'o e anterolateral) 'i he taimi pe ko ia kapau 'oku 'i ai ha faingata'a'ia 'i he manava pe ko e ma'ulalo 'a e toto.
5. Ako 'a e Mahaki Kimu'a pea Faka'ata: Fakapapau'i 'a e mahaki (pea fakatohi mahino 'i he'enau saati fakafaito'o) na'a nau mamahi'ia 'i he Scombroid (histamine) kona 'o e me'akai mei he ika 'oku 'ikai ke fakamokomoko totonu, 'ikai ko ha allergy ika fo'ou, ko ia 'oku 'ikai fie ma'u ke nau fakahingoa dyaalest allergic or se

Syndrome 3 & 4: Ngaahi Neurotokisini 'o e ika 'o e 'anga'anga: Amnesic (Domoic Acid) vs. Neulotokisi (Brevetoxin) vs. Palalisia (Saxitoxin)¶

1. Fakakonahi ‘o e Ika ‘o e ‘Amnesic (ASP: Domoic Acid)¶

• Ma'u'anga mo e Founga: Ngaohi 'e he ngaahi diatoms 'o e tahi 'o e fa'ahinga Pseudo-nitzschia 'i he tafa'aki 'o e Tokelau Hihifo 'o e Pasifiki, Kalefōnia, 'Atalanitiki Kanata (Motu Pilinisi 'Etuate, 'a ia na'e hoko ai 'a e fuofua mahaki 'o e tangata 'i he 1990). 1987), ʻIulope, mo Nuʻu Sila. ** 'Esiti Domoic ** ko ha fakatata fakafa'unga 'o e ** 'esiti kainic ** mo e fakatupu 'o e 'uto ** L-glutamate **. 'Oku ne ha'i 'aki 'a e affinity ma'olunga ki he ** AMPA mo e kainate glutamate receptors ** mamafa 'i he ** CA1 mo e CA3 'o e ngaahi vahenga 'o e hippocampus 'o e tangata ** mo e amygdala, 'o fakatupu 'a e kalasiume ta'etuku (Ca2+) influx mo e nekolosi faka'ofo'ofa 'o e neula.
• Kosi Fakakiliniki: 'I loto 'i he 15 minutes to 24 hours ‘o e kai ‘a e musie ‘uli‘í, ngaahi fo‘i ‘uhiki‘i manupuna, pe ngaahi viscera ‘o e pāpa‘i Dungeness, ‘oku hoko ai ‘a e kau ma‘unimaá ‘o kafo, lua, mo e kafo ‘i he keté. 'I loto 4 to 48 hours (tautautefito ki he kakai lalahi matu'otu'a pe kau mahaki 'oku nau ma'u 'a e mahaki 'o e fatú, talu mei he 'esiti domoic 'oku fakama'a renally), 'oku hoko 'a e kona lahi 'o e neave: ** puputu'u, ta'e'ilo, mutism, lamu / grimacing 'otometiki, toto ta'epau, myoclonus, refractory tu'unga co ** epilep. 'Oku fa'a mamahi 'a e kau hao mo'ui mole 'a e manatu taimi nounou anterograde tu'uma'u (ta'emalava ke fa'u ha ngaahi manatu fo'ou hili 'a e me'akai, 'oku tatau mo e Korsakoff psychosis pe resection hippocampal fakatou'osi).
• Faito'o: 'Oku 'ikai ha faito'o. Fakahoko vave 'a e malala 'oku faka'aonga'i (within 1 to 2 hours), fakatupu 'ita hydration 'i he veini ke fakalahi 'a e fakama'a 'o e renal 'o e vai-soluble domoic 'esiti, mo e tu'unga ma'olunga GABA-A agonists (IV lorazepam, midazolam, phenobarbital, mo e . propofol) ke ta'ofi 'a e tu'unga 'o e hippocampal excitotoxic 'o e mahaki faka'auha (phenytoin is ineffective against domoic acid seizures).

2. Fakakonahi ‘o e Ika ‘o e Neurotoxic (NSP: Brevetoxin)¶

• Ma'u'anga mo e Founga: Na'e ngaohi 'e he dinoflagellate 'oku 'ikai ke 'i ai ha me'atau Karenia brevis (formerly Gymnodinium breve), ko e me'amo'ui 'oku ne fatongia'aki 'a e Fololita mo e Gulf 'o Mekisikou "Red Tides" (mo e ngaahi matala'i'akau tatau 'i Nu'u Sila). Ngaahi kona fakavavevave ( (Gulf of Mexico)PbTx) ha'i ki he Saiti 5 'i he ngaahi halanga sotiume voliume-gated, 'a e saiti receptor tatau tofu pe mo e Ciguatoxin.
• Ko e Hala 'e Ua 'o e Faka'ali'ali:
• Kami 'o e Ika 'o e Ngutu: Ko e kai 'o e 'osita, kalami, pe coquinas 'oku 'uli 'oku ne fakatupu 'a e tingling 'o e loungutu, 'elelo, mo e ngutu 'i loto 'i he 30 minutes to 3 hours, pea hoko atu ki he lua, 'uto, 'uto, ataxia, Cold Allodynia (hot-cold temperature reversal), ngaahi mata ʻo e fānau akó ʻoku fakalahi, mo e bradycardia siʻisiʻi. ‘Oku ‘ikai ke hangē ia ko e Fakakonahi ‘o e Ika ‘o e ‘Aá (Saxitoxin), 'Oku 'IKAI fakatupu 'e he NSP 'a e palalisia 'o e manava, pea 'oku mo'ui kakato 'a e kau mahaki 'i loto 'i he 2019. 2 to 3 days mo e ngaahi vai IV poupou.
• Ko e huhu 'o e 'ea 'o e 'ea 'i he matātahi ("Tale 'o e Tafe Kulokula"): Koe'uhi ko e ngaahi selo 'o e Karenia brevis 'oku vaivai pea 'oku 'ikai ha'anau fo'i 'anga'anga fefeka, 'oku lyse 'e he ngaahi peau 'o e 'oseni 'oku tō 'a e 'ulu'akau pea 'oku ne faka'ata 'a e brevetoxin 'oku lipid-soluble ki he ngaahi 'ea 'o e tahi spray. Ko e kau ‘alu ki he matātahí mo e kau nofo ‘i he matātahí ‘oku nau mānava‘i ‘a e kakapú ‘oku nau tupulaki vave (within 5 to 15 minutes) vela 'a e mata, rhinorrhea, tale hacking 'ikai ola lelei, mo e bronchospasm lahi 'i he kakai 'oku nau ma'u 'a e mahaki mafu pe COPD. Hiki ki loto fale ki ha fale 'oku 'ea-fakamokomoko pea fakahoko 'a e inhaled beta-2 agonists (albuterol) vave hono fakalelei'i 'o e ngaahi faka'ilonga.

Ngaahi polokalama fakavavevave fakavahefonua mo e lipooti tahi¶

• 'Amelika mo Kanata: Ta ki he 911 ki ha ngaahi me'a fakatu'upakee 'i he manava, loto, pe neave, pea fetu'utaki ki he Pule'i 'o e Kona (1-800-222-1222 'i 'Amelika; 1-844-POISON-X 'i Kanata). ‘I Folōlita, ko e Kōlomu ‘o Mekisikoú, Pueto Liko, ‘Otu Motu Tāupo‘ou ‘o ‘Ameliká, mo Hauai‘í, ‘oku fakatoka ai ‘e he ngaahi potungāue fakavavevavé . (Gulf of Mexico) 20% Mannitol ki he infusion vave 'o e Ciguatera, pea 'oku kole 'e he ngaahi potungaue 'o e mo'ui 'a e siteiti 'a e toenga 'o e me'akai 'aisi ki he FDA Senita ki he Malu 'o e Me'akai mo e Me'akai Faka'aonga'i (CFSAN) sivi.
• Pule'anga Fakatahataha mo e 'Iunioni 'a 'Iulope: Ta mai ki he 999 (UK) pe 112 (EU). 'Oku fetu'utaki 'a e kau toketaa ki he NPIS / TOXBASE (Pilitānia) pe ngaahi senitā kona fakafonua 'o e EU (CAPTV ‘i Falanisē, ‘a ia ‘okú ne toe fakafekau‘aki ‘a e ngaahi vahefonua muli ‘o Falanisē ‘i he ‘Otu Kalipiané [ 1 ].Guadeloupe, Martinique] mo e Pasifiki [ 1 ].French Polynesia, New Caledonia] ‘a ia ‘oku fu‘u lahi ai ‘a e Ciguatera). Tānaki atu ki aí, ko e fanga ki‘i ‘amberjack (Seriola) mo e barracuda ‘oku ma‘u fakalotofonuá ‘i he ‘Otu Motu Kēnalí, Mateila, mo e fakahahake ‘o e Metiteleniané ‘oku nau fakatupunga he taimí ni ‘a e ngaahi mahaki faka‘auha ‘o e Ciguatera ‘Iulopé.
• Aositelelia, Nu'usila, mo e Ngaahi 'Otu Motu Pasifiki: Ta ki he 000 ('Aositelelia) pe 111 (Nu'usila), pea fetu'utaki ki he Senitā Fakamatala ki he Ngaahi Kona (13 11 26 ʻi ʻAositelēlia; 0800 764 766 'i Nu'usila). 'I Kuinisilani, 'i he Vahefonua Tokelau, Fisi, Ha'amoa, Tonga, mo Vanuatu, Ciguatera mei he ika 'o e 'ao, ika 'o e Sipeini, 'o e red bass, mo e ika chinaman ko ha fakahaa'i fakafaito'o lahi 'oku pule'i 'aki 'a e IV crystalloids, atropine, mo e kamata'anga 'o e 20% manitoli (1.0 g/kg).
• Esia (Hong Kong, Siapani, Filipaini, Tonga-hahake 'o 'Esia): Fefakatau'aki me'akai-ika 'o e 'ao mo'ui (grouper, humphead wrasse, snapper) ‘okú ne fakatupunga ‘a e toutou ‘i ai ‘a e ngaahi kulupu ‘o e Ciguatera ‘i he kotoa ‘o Hong Kong, fakatonga ‘o Siainá, mo e Tonga-hahake ‘o ‘Ēsiá; ‘oku fakamālohi‘i ‘e he ngaahi senitā kona fakavahefonuá ‘a e . 48-to-72-hour IV mannitol window mo e faka'ehi'ehi fefeka 'i he mahina 'e 6 mei he ika, kavamalohi, mo e nati.

Ngaahi fehu'i 'oku toutou 'eke .¶

Ko e ha e "cold allodynia" (fakafoki vela-mokomoko) pea ko e ha e ngaahi kona 'o e me'akai tahi 'oku ne fakatupu ia?¶

Ko e allodynia momoko (ʻoku faʻa ui ko e vela-mokomoko ʻo e mafana ʻo e ʻea) ko ha fakaʻilonga neurological pathognomonic ʻa ia ʻoku fakatupu ai ʻe he pa ki he vai momoko, puke ha inu ʻaisi, pe laka ki ha faliki momoko ha vela mamahi, vela, pe ʻuhila-shock ʻi he kili mo e ngutu. 'Oku hoko ia koe'uhi ko e Ciguatoxin (mei he ika 'o e 'aofi fakatalopiki hange ko e barracuda, grouper, mo e snapper) mo e Brevetoxin (mei he ika kulokula-tafe) loka'i fakaava 'a e ngaahi halanga sotiume voliume-gated 'i he ngaahi filo neave peripheral 'oku ongo'i momoko, 'o fakatupu ai ke nau afi fakamālohi besilow 'i ha taimi pe 'oku C26.

Ko e ha kuo pau ai ke ma'u 'e ha mahaki 'a e ngaahi vai masima 'i he veini KIMU'A pea toki ma'u 'a e IV Mannitol ki he Ciguatera?¶

'Oku ngaue 'a e 20% Mannitol (1.0 g/kg infused 'i he miniti 'e 30 ki he 45 'i loto 'i he houa 'e 48 ki he 72) 'aki hono to'o 'a e vai lahi ange mei he ngaahi selo Schwann 'oku fula 'oku ne takatakai'i 'a e ngaahi neave peripheral kona, vave hono fakanonga 'o e Ciguatera 'a e 'ikai ke ngaue mo e mamahi. Ka neongo ia, koe'uhi 'oku kamata 'a e Ciguatera 'aki 'a e lua lahi, 'a e vai 'o e 'uto, mo e vagal 'a e toto ma'ulalo, pea ko e mannitol ko ha diuretic osmotic malohi 'oku ne toho 'a e vai ki he mimi, 'o 'oange 'a e mannitol kimu'a pea toki rehydrating kakato 'a e mahaki 'aki 'a e 1 ki he 2 lita 'o e saline angamaheni 'e lava ke ne fakatupu 'a e kishock fakatu'utamaki damageney hypovolemic mo e mannitol.

Ko e ha 'oku 'ikai lava ai ha taha 'o mo'ui mei he Ciguatera 'o inu kavamalohi pe kai ha fa'ahinga ika pe nati 'i he mahina 'e 6?¶

'Oku fu'u ngako-soluble 'a e Ciguatoxin pea 'oku nofo 'o ha'i ki he ngaahi membranes 'o e neave peripheral mo e ngako 'o e sino 'i ha ngaahi mahina hili hono fakalelei'i 'o e 'uluaki gastroenteritis. Ko hono inu kavamalohi, ha fa'ahinga ika pe ika 'o e 'anga'anga (na'a mo e ika malu 'o e vai ma'a pe salmon 'i he puha), pīnati, nati 'akau, caffeine, pe sokoleti 'i loto 'i he mahina 'e 3 ki he 6 'oku ne fakatupu ha fakafokifā, toe foki mai 'a e mamahi 'o e neave vela, ferocious itching, prosound pressure mo e toto ma'ulalo.

Te ke lava fēfē ʻo ʻiloʻi ʻa e kona ʻo e ika Scombroid ʻo mavahe mei ha ʻalelisi moʻoni ʻo e meʻakai tahi ʻi he moʻuí kotoa?¶

Ko e kona fakatou‘osi ‘o e Scombroid mo ha tali ‘a e sinó ‘okú na fakatupunga ‘a e fulufulua ‘o e fofongá, ‘u‘ulu, pā ‘a e mafú, mo e ngingila ‘i loto ‘i he miniti ‘e 10 ki he 60 ‘o e kai ‘o e iká, pea ‘okú na fakatou tali ki he ngaahi faito‘o fakafepaki‘i ‘o e iká (pea mo e epinephrine kapau ‘oku lahi). Ka neongo ia, 'Oku hoko 'a e Scombroid mei he kai 'o e ika 'uli'uli-kakano'i manu (tuna, mahi-mahi, mackerel, bluefish) na'e tuku 'o 'ikai fakamokomoko, 'o faka'ata 'a e fanga ki'i selo ke liliu 'a e uoua histidine ki he histamine: 'oku fa'a ifo 'a e ika peppery pe ukamea, tokolahi 'a e kakai na'a nau vahevahe 'a e ipu 'oku nau ma'u 'a e mahaki 'a e IOT trues toge, pea lava ke toe kai malu ‘a e ika fo‘ou ‘i he kaha‘ú.

Ko e hā ʻoku fuʻu fakatuʻutāmaki lahi ai ʻa e kau mahaki ʻoku nau toʻo ʻa e Isoniazid (INH) ki he mahaki pipihí mei he ika Scombroid?¶

Ko e isoniazid (INH) mo e ngaahi me‘a faka‘auha ‘o e monoamine (MAOIs) ‘oku nau ta‘ofi mālohi ‘a e ‘okisaiti (DAO, pe histaminase), ko e ‘enisaimi fakanatula ‘i he ‘ā ‘o e ‘uto ‘o e tangatá ‘a ia ‘okú ne holoki ‘a e histamine ‘o e me‘akaí ki mu‘a ke ne hū ki he totó. Kapau ‘oku kai ‘e ha tokotaha mahaki ‘oku ne to‘o ‘a e isoniazid ‘a e tuna, mahi-mahi, pe mackerel ‘oku ‘i ai na‘a mo e ngaahi tu‘unga fakafuofua ‘o e histamine, ‘oku tāfea ‘e he histamine ‘oku ‘ikai ke fakafetongi ‘enau tafe ‘i he sinó, ‘o fakatupunga ai ‘a e fulufulua ‘o e sinó, mamahi ‘ulu ‘oku pā, ‘oho lahi ‘i he mafú, mo e ‘ohovale ‘i he mālohí.

Ko hono faka‘aisi ‘o e iká pe fakamāfana‘i ia ‘i he vai laimé ki he ceviche ‘okú ne tāmate‘i ‘a e ngaahi kona ‘o e Ciguatera pe Scombroid?¶

‘Ikai, ‘oku ‘ikai ke faka‘auha ‘a e Ciguatoxin, Scombroid histamine, pe ko e ngaahi me‘a fakatupu mo‘ui ‘o e ika ‘o e ‘anga‘angá (‘esiti Domoic, Brevetoxin, Saxitoxin) ‘aki hono faka‘aisi, fakavela, tunu, ta‘o, ifi, pe ngaahi me‘akai ‘oku ‘i ai ‘a e vai laime ‘esiti. Lolotonga hono tauhi 'o e tuna fo'ou pe mahi-mahi chilled 'i he 'aisi 'i lalo 'i he 4.4 tikili Selisiasi (40 tikili Fahrenheit) mei he momeniti 'oku ma'u ai 'oku ne ta'ofi 'a e pekitilia mei hono ngaohi 'o e histamine fo'ou, 'i he taimi pe 'oku histamine pe ciguatoxin 'i he fillet, 'oku 'ikai ha founga tunu safe 'e lava ke ne ngaohi ia.

Ke teuteu ki he ngaahi fakatuʻutāmaki fakafaitoʻo ʻoku tupu mei he meʻakaí, ʻaleliá, mo e fefonongaʻakí, fakakaukau ke fai ha ako tokoni ʻuluaki mo e CPR mei he Kolosi Kulokulá, St John Ambulance, pe ko ha tokotaha ako fakalotofonua kuo fakamoʻoniʻi.

Ngaahi fakahinohino fekau'aki¶

• Botulism, Sikuatela, Scombroid, mo e Fakakaukau Fakalukufua ki he Kona 'o e Neurotoxin 'o e ika 'o e 'anga'anga
• Ngaahi tali 'o e 'Alelia mo e Anaphylaxis 'Uluaki Tokoni .
• Rebound Anaphylaxis, Tali 'a e Biphasic 'o e 'Alelia, mo e taimi 'o e EpiPen hono ua .
• Ko e Kona ‘o e Me‘akaí, Gastroenteritis Fakatu‘utāmaki, mo e ‘Ikai ‘a e Vaí
• Fakakonahi Fakalukufua Tokoni 'Uluaki mo e Faka'auha 'o e 'uli

Ngaahi ma'u'anga fakamatala mo e fakahinohino faka'ofisiale .¶

• ʻAmelika Senita ki hono Pule'i mo e Ta'ofi 'o e Mahaki (CDC): Tohi Kulokula 'a e CDC (Ngaahi Fakamatala ki he Mo'ui Lelei ki he Fefononga'aki Fakavaha'apule'anga): Kona 'o e Me'akai mei he Ngaahi Kona 'o e Tahi (Ciguatera, Scombroid, mo e Kona 'o e Ika 'o e 'Alu) ('Iunaiteti Siteiti).
• KIMAUTOLU. Pule'anga 'o e Me'akai mo e Faito'o (FDA): Tohi 'o e Bug Kovi (Ngaahi me'amo'ui 'oku fakatupu mahaki 'i he me'akai mo e ngaahi kona fakanatula, Pulusinga hono 2): Scombrotoxin (Hisitamin), Sikuatokisini, 'Esiti Domoic (ASP), Brevetoxini (NSP), mo e Saxitoxini (PSP ngaahi pule'anga) (U).
• Kautaha Mo'ui 'a Mamani (WHO) & Kautaha Me'atokoni mo e Ngoue (FAO): Lipooti 'o e Fakataha 'a e Kau Mataotao ki he Fakakonahi 'o e Ciguatera mo e Biotoxins 'o e Tahi 'i he Bivalve Molluscs (Loma / Sene).
• Sevesi Fakamatala ki he Ngaahi Kona Fakafonua 'a Pilitania (NPIS) / TOXBASE: Pule'i Fakafaito'o 'o e Kona 'o e Ika Ciguatera (Mannitol Protocol), Kona 'o e Ika Scombroid, mo e Neurotoxins 'o e Ika 'o e 'Alu'anga (Pule'anga Fakatahataha).
• Friedman MA, Fleming LE, Fernandez M, Bienfang P, mo e ni'ihi kehe: Ko e kona 'o e ika 'o e Ciguatera: faito'o, ta'ofi mo e pule'i (Ngaahi faito'o konatapu 'o e tahi / Palafox NA ngaahi ako 'o e mannitol 'i he veini).