Overview
Paralytic shellfish poisoning (PSP) is a foodborne illness resulting from consumption of shellfish contaminated with saxitoxin or related neurotoxins, leading to symptoms ranging from mild gastrointestinal distress to severe neurological complications 2. Climate change is facilitating the northward migration of toxic algal blooms responsible for PSP 1.Diagnosis
Clinical presentation includes gastrointestinal symptoms (nausea, vomiting, diarrhea) progressing to neurological symptoms (tingling, numbness, paralysis) 2.
Laboratory tests typically show elevated white blood cell counts and electrolyte imbalances secondary to vomiting and dehydration 2.
Grading systems for severity exist but are not detailed in the provided abstracts 2.Management
Supportive care: Focus on airway management, fluid resuscitation, and monitoring for complications 2.
Activated charcoal: May be considered for decontamination if administered early post-ingestion 2.
Specific antidotes: No specific antidote for saxitoxin is widely established; treatment remains symptomatic 2.Special Populations
Pregnancy: Specific management guidelines not provided; supportive care principles apply 2.
Pediatrics: Increased risk of severe neurological symptoms; close monitoring and supportive care are crucial 2.
Elderly: Higher susceptibility to complications; vigilant monitoring and fluid management are essential 2.
Comorbidities: Patients with pre-existing conditions may require tailored management focusing on exacerbations and supportive care 2.Key Recommendations
Prompt recognition and discontinuation of shellfish consumption upon suspicion of PSP outbreak (Evidence: Expert opinion 2).
Initiate supportive care measures including airway protection and fluid resuscitation (Evidence: Expert opinion 2).
Monitor for neurological progression closely in vulnerable populations such as the elderly and pediatric patients (Evidence: Expert opinion 2).References
1 Gannon M. Bering Strait hit by unprecedented algal bloom. Science (New York, N.Y.) 2024. link
2 . Paralytic shellfish poisoning--Massachusetts and Alaska, 1990. MMWR. Morbidity and mortality weekly report 1991. link