Puffer Fish Dinner Case Study

Dr. Marshall Westwood had a meal of puffer fish and rice for dinner in Indonesia on his recent trip. Within an hour, the numbness starting from his lips and tongues quickly spread out through his face and neck, and he had pains in stomach and throat with symptoms of severe nausea and vomiting.
Dr. Westwood called a local hospital, for he was feared of a “bad fish” food poisoning. He told his condition and signs to hospital staff but it were impossible to speak due to the numbness of lips and face. But the staff understood and Dr. Westwood got an ambulance and reached to ED. He presented with diaphoresis, motor dysfunction, paresthesia, nausea, and ascending paralysis from his leg to the upper body, arms, face and head. He became cyanotic and hyperventilating and it turned to be bradycardiac with a BP 90/50mmHg. After five hour long clinical treatment procedures were followed for tetrodotoxin poisoning, his vital signs were

Westwood experienced numbness after eating the puffer fish meal because TTX inhibited neurons that function as bringing sensory information to the brain. After TTX prevented the generation of action potentials in sensory nerves, there is no interaction between motor neurons, interneuron and sensory neurons that are supposed to communicate each other as roles of information messengers. Therefore, the numbness would be presented due to the loss of neuron activities.
Dr. Westwood experienced paralysis since muscles contract after receiving signals from motor neurons. Because TTX prevented the generation of action potentials in these neurons, it was impossible that the motor neurons could be activated. So, the result was presented as the emergence of paralysis in the affected areas. Initial blockage of sodium ion channel totally deactivated an entire process in the neuromuscular junction. In other words, sodium ions mainly influence to the action potential generated in muscle cells, so TTX may inhibit muscle activity