One evening during a recent trip to Indonesia, Dr. Marshall Westwood from the Montana Technical Institute sat down to a meal of puff erfi sh and rice. Within an hour of returning to his hotel room, Dr. Westwood felt numbness in his lips and tongue, which quickly spread to his face and neck. Before he could call the front desk, he began to feel pains in his stomach and throat, which produced feelings of nausea and eventually severe vomiting. Fearing that he had eaten some âbad fi shâ for dinner, Dr. Westwood called a local hospital to describe his condition. Th e numbness in his lips and face made it almost impossible for him to communicate, but the hospital staff managed to at least understand the address he gave them and they sent an ambulance in response. As Dr. Westwood was rushed to the hospital, his breathing became increasingly diffi cult. Doctorâs Notes Th e patient presented in the ED with severe headache, diaphoresis, motor dysfunction, paresthesias, nausea, and an ascending paralysis that spread to the upper body, arms, face, and head. Th e patient was cyanotic and was hypoventilating. Within 30 minutes of presenting in the ED, Dr. Westwood developed bradycardia with a BP of 90/50. Atropine was administered in response to the bradycardia. IV hydration, gastric lavage, and activated charcoal followed a presumptive diagnosis of tetrodotoxin poisoning based on the clinical presentation in the ED. Five hours after intervention, the following vitals were noted: ⢠BP 125/79 ⢠HR 78bpm ⢠Oxygen saturation: 97% on room air Follow-up Within a few hours, Dr. Westwoodâs condition improved and he was on his way to a full recovery. After discussing his case with his physician, he learned that he had probably been the victim of a puff erfi sh poisoning. Th e active toxin in the tissues of this fi sh is a chemical called tetrodotoxin. Tetrodotoxin is in a class of chemicals known as neurotoxins due to the fact that it has its eff ects on nerve cells (neurons). Specifi cally, tetrodotoxin blocks voltage-gated sodium ion channels on neurons.
12. Now that you have addressed some of the basic biology of this case, explain why Dr. Westwood experienced numbness after eating the puff erfi sh meal.
13. Paralysis is a term used to describe the loss of function of muscle. If tetrodotoxinâs eff ect is on neurons, why did Dr. Westwood experience paralysis?
14. Explain how tetrodotoxin is involved in the development of hypotension and hypoventilation
One evening during a recent trip to Indonesia, Dr. Marshall Westwood from the Montana Technical Institute sat down to a meal of puff erfi sh and rice. Within an hour of returning to his hotel room, Dr. Westwood felt numbness in his lips and tongue, which quickly spread to his face and neck. Before he could call the front desk, he began to feel pains in his stomach and throat, which produced feelings of nausea and eventually severe vomiting. Fearing that he had eaten some âbad fi shâ for dinner, Dr. Westwood called a local hospital to describe his condition. Th e numbness in his lips and face made it almost impossible for him to communicate, but the hospital staff managed to at least understand the address he gave them and they sent an ambulance in response. As Dr. Westwood was rushed to the hospital, his breathing became increasingly diffi cult. Doctorâs Notes Th e patient presented in the ED with severe headache, diaphoresis, motor dysfunction, paresthesias, nausea, and an ascending paralysis that spread to the upper body, arms, face, and head. Th e patient was cyanotic and was hypoventilating. Within 30 minutes of presenting in the ED, Dr. Westwood developed bradycardia with a BP of 90/50. Atropine was administered in response to the bradycardia. IV hydration, gastric lavage, and activated charcoal followed a presumptive diagnosis of tetrodotoxin poisoning based on the clinical presentation in the ED. Five hours after intervention, the following vitals were noted: ⢠BP 125/79 ⢠HR 78bpm ⢠Oxygen saturation: 97% on room air Follow-up Within a few hours, Dr. Westwoodâs condition improved and he was on his way to a full recovery. After discussing his case with his physician, he learned that he had probably been the victim of a puff erfi sh poisoning. Th e active toxin in the tissues of this fi sh is a chemical called tetrodotoxin. Tetrodotoxin is in a class of chemicals known as neurotoxins due to the fact that it has its eff ects on nerve cells (neurons). Specifi cally, tetrodotoxin blocks voltage-gated sodium ion channels on neurons.
12. Now that you have addressed some of the basic biology of this case, explain why Dr. Westwood experienced numbness after eating the puff erfi sh meal.
13. Paralysis is a term used to describe the loss of function of muscle. If tetrodotoxinâs eff ect is on neurons, why did Dr. Westwood experience paralysis?
14. Explain how tetrodotoxin is involved in the development of hypotension and hypoventilation
