title: Severe scombroid fish poisoning syndrome requiring aggressive fluid resuscitation in the emergency department: two case reports.
abstract: Scombroid fish poisoning (scombrotoxism, scombroid ichthyotoxicosis) is a food-related illness typically associated with the consumption of dark and white meat fish. Two patients presented to the emergency department. Metilprednisone 1000 mg and ranitidine 150 mg were administered initially. A large amount of crystalloids and colloids in in combination with vasoactive drugs were required to maintain normopressure. Levels of histamine and N-methylhistamine were far above the normal mean. Carboxyhemoglobin levels were also tested to exclude a superimposition of carbon monoxide intoxication. In both cases, major symptoms occurred and were treated aggressively. Early goal directed fluid therapy corrected the DO2/VO2 unbalance, due to a distributive pattern of hypovolemic impending shock, and permitted a rapid stabilisation of both patients. It is important to recognize the syndrome as an intoxication (rather than an allergic reaction) so that the source of the toxin can be identified and further cases prevented. It is also important to investigate where the fish was cooked (i.e. in an open space vs. closed space), to exclude the possibility of a concomitant carbon monoxide intoxication, which would require transfer the patient to a hospital facility equipped with a hyperbaric chamber.
authors.affiliation: Intensive Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy. micheleiannuzzi@libero.it
authors.forename: M
authors.initials: M
authors.lastname: Iannuzzi
authors.forename: N
authors.initials: N
authors.lastname: D'Ignazio
authors.forename: L
authors.initials: L
authors.lastname: Bressy
authors.forename: A
authors.initials: A
authors.lastname: De Sio
mesh_terms: D000293:Adolescent; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004632:Emergency Medical Services; D005440:Fluid Therapy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use; D017747:Seafood / Q000506:poisoning*; D014413:Tuna
chemical_list: D000893:Anti-Inflammatory Agents; D006635:Histamine H2 Antagonists; D011899:Ranitidine; D008775:Methylprednisolone