Difference between revisions of "Scombroid"

(Text replacement - "Category:Environ" to "Category:Environmental")
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==Background==
 
==Background==
*Common in Hawaii, then FL
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*Caused by eating fish which have been improperly stored/refrigerated
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**Bacteria grow and produce heat-stable toxin that causes histamine release when consumed<ref name="Craig">Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222</ref>
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**Patient may complain that the fish tasted like pepper, metallic, or bitter
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*Commonly associated fish include: tuna, bluefish, mahi-mahi, herring, mackerel, skip-jack, sardine, and bonito
 
*Frequently misdiagnosed as seafood allergy
 
*Frequently misdiagnosed as seafood allergy
*Most of the cases associated with tuna, bluefish, and mahi-mahi
 
**Also herring, mackerel, skip-jack, sardine, and bonito
 
*Bacteria in fish produce produce heat-stable toxins causing histamine release when consumed<ref>Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222</ref>
 
  
 
==Clinical Presentation==
 
==Clinical Presentation==
*Fish dish taste metallic, bitter, or peppery<ref>Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222</ref>
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*Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated)
*Starts within one hour of ingestion
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*Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea
**Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea within 30 min of consumption
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*May also see severe throbbing headache, blurred vision, tachycardia, and respiratory distress
**Severe throbbing headache, blurred vision, dizziness
 
**Significant tachycardia, palpitations, and possible respiratory distress
 
*Usually resolves within 12 hours if untreated and has no long-term sequelae
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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{{Template:Acute Allergic DDX}}
 
{{Template:Acute Allergic DDX}}
  
==Diagnosis ==
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==Diagnosis==
Usually clinical
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*Generally clinical diagnosis
  
==Treatment==
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==Management==
*H1 and H2 agonists
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*Antihistamines - give both H1 and H2 antagonists
*Epi and albuterol if bronchospasm
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*Consider epinephrine, albuterol if sx of respiratory distress
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==Disposition==
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*Generally may be discharged
  
 
==See Also==
 
==See Also==
 
*[[Marine toxins and envenomations]]
 
*[[Marine toxins and envenomations]]
  
==Source==
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==References==
 
<references/>
 
<references/>
  
 
[[Category:Dermatology]]
 
[[Category:Dermatology]]
 
[[Category:Environmental]]
 
[[Category:Environmental]]

Revision as of 03:58, 4 April 2016

Background

  • Caused by eating fish which have been improperly stored/refrigerated
    • Bacteria grow and produce heat-stable toxin that causes histamine release when consumed[1]
    • Patient may complain that the fish tasted like pepper, metallic, or bitter
  • Commonly associated fish include: tuna, bluefish, mahi-mahi, herring, mackerel, skip-jack, sardine, and bonito
  • Frequently misdiagnosed as seafood allergy

Clinical Presentation

  • Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated)
  • Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea
  • May also see severe throbbing headache, blurred vision, tachycardia, and respiratory distress

Differential Diagnosis

  • Ciguatera - similar clinical presentation, different fish

Acute allergic reaction

Diagnosis

  • Generally clinical diagnosis

Management

  • Antihistamines - give both H1 and H2 antagonists
  • Consider epinephrine, albuterol if sx of respiratory distress

Disposition

  • Generally may be discharged

See Also

References

  1. Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222