title: Severe bradycardia and prolonged hypotension in ciguatera.
abstract: Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China. tykchan@cuhk.edu.hk
authors.forename: Thomas Yan Keung
authors.initials: TY
authors.lastname: Chan
mesh_terms: D000818:Animals; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis*; D036841:Ciguatera Poisoning / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D002922:Ciguatoxins / Q000009:adverse effects; D005399:Fishes; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged
chemical_list: D002922:Ciguatoxins