Palytoxin: deadlier than fugu?

December 5, 2014, 1:22 am




Hyperkalemia, Hyperphosphatemia, Acute Kidney Injury, and Fatal Dysrhythmias After Consumption of Palytoxin-Contaminated Goldspot Herring. Wu M: et al. Ann Emerg Med 2014 Dec;64:633-6.


Palytoxin, a huge heat-stable molecule, is one of the most deadly of all the marine toxins. Fortunately, cases of severe palytoxin poisoning are relatively rare. This paper from Taiwan describes 4 patients from a single family who became symptomatic after eating fish soup made from the local catch. One person died. The presence of palytoxin was confirmed in samples of leftover fish.

The following questions are based on point made in the paper. Click on the question to reveal the answer:

Palytoxin poisons the membrane sodium-potassium pump, impairing the ability of cells to maintain electrical gradients. Essentially, it turns the normally carefully regulated pump into an open non-specific cation channel. Sodium ions rush into the cell — creating a permanent state of depolarization —  along with calcium ions that ultimately cause cell death. Calcium also mediates release of neurotransmitters, histamine, and catecholamines.

Palytoxin is a potent vasoconstrictor, especially affecting heart and kidney vessels.

    • Goldspot herring (Herklotsichthys quadrimaculatus)
    • boxfish
    • filefish
    • trigger fish
    • cowfish
    • parrotfish
    • freshwater puffer fish
    • Sea anemones
    • Crabs
    • mackerel
    • Anchovies
    • Sardines

Palytoxin itself is probably produced by dinoflagellates such as Ostreopsis Fish and other marine creatures acquire the toxin by eating plankton.

  • Neurological: dizziness, perioral and limb paresthesias, weakness.
  • Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain
  • Cardiovascular: hypertension, bradycardia, dysrhythmias
  • Renal: acute renal failure (from rhabdomyolysis), anuria
  • Other: myalgia, muscle spasm, respiratory distress,arthralgia, acute hyperkalemia, acute hyperphosphatemia

Many marine envenomations can present in a similar manner, including tetrodotoxin poisoning, neurotoxic shellfish poisoning, paralytic shellfish poisoning (saxitoxin). The major alternative diagnosis is usually ciguatera.

Supportive care with aggressive hydration to maintain urine output.

Goldspot herring (Herklotsichthys quadrimaculatus)

Goldspot herring (Herklotsichthys quadrimaculatus)