Clinical presentation of tetrodotoxin poisoning

Clinical effects of tetrodotoxin poisoning occur within 1 to 2 hours of ingestion of puffer fish. Onset may be more rapid with severe poisoning due to ingestion of puffer fish. Clinical effects of tetrodotoxin poisoning include:

• neurological effects—perioral numbness and paraesthesia, distal limb numbness and paraesthesia, ataxia, dizziness, muscle weakness
• gastrointestinal effects—nausea (common); vomiting (less common)
• other effects in severe cases—respiratory muscle paralysis, coma, hypotension, arrhythmias.