Continued from Page 1

Symptoms may be more severe in patients taking certain medications that retard the liver’s breakdown of histamine, such as isoniazide and doxycycline.¹ In general, people with weakened immune systems or liver problems should not eat raw seafood because of the higher risk of toxic infection. Patients with comorbid illnesses like coronary artery disease risk acute coronary syndromes caused by the tachycardia and hypotension associated with severe cases of scombroid poisoning.⁶

Remember: Scombroid poisoning is not an allergic reaction (anaphylaxis). Thus, it does not require the traditional adrenaline injections or corticosteroid dose packs. Nor is scombroid poisoning an infection; antibiotics therefore have no effect on symptoms. As noted earlier, most episodes are successfully treated with quick-acting conventional antihistamine tablets.

What the patient needs to know

Patient education should emphasize that if freshly caught fish won’t be frozen soon after being caught, it should immediately be refrigerated and eaten the same day. What’s more, patients should be taught that while affected fish may have a peppery taste, a normal taste does not guarantee safety.²

With fish bought at a supermarket or butcher, all purchases should be kept on ice or refrigerated at colder than 38 F to prevent spoilage.¹ Patients should also be told to avoid eating finfish or shellfish sold as bait, since such products aren’t required to meet the same food safety
regulations as seafood for human consumption. Additionally, it’s wise to urge patients to check with local health officials before collecting shellfish and look for any state or local health department advisories posted at fishing supply stores.

Get the word out

It’s important that health care staff notify the proper authorities of any suspected marine toxin cases so that officials may investigate whether a restaurant, oyster bed, or fishing area has posed a recurrent problem.

And while the health department can report issues and activities specific to your area, the Centers for Disease Control and Prevention in Atlanta is an invaluable source for information — the agency publishes the Morbidity and Mortality Weekly Report, which can be viewed at www.cdc.gov/mmwr.

Patients also need education regarding food consumed while traveling outside the country. They should be advised to avoid cooked food that has been kept at room temperature for several hours — and then only if food has been thoroughly cooked and is still hot when brought to the table. They should always avoid food bought from street vendors. It’s also wise to get information from local health agencies about any concerns over fish-related biotoxin occurrences in their area.⁷

A final cautionary note: Scombroid poisoning in most cases is likely to be less a hazard than an inconvenience, one that is quickly and easily treated with an antihistamine and, in some cases, activated charcoal. But for those with a compromised immune system or liver disease, the risks are much more severe. Making sure that such patients understand those risks is every nurse’s responsibility.

*Composite patient.

Maureen G. Sullivan-Tevault, RN, CEN, works in the pain management department at the VA Medical Center in Bay Pines, Fla.

References

1. Marine Toxins. Centers for Disease Control and Prevention Website. Available at: www.cdc.gov/ncidod/dbmd/diseaseinfo. Accessed January 17, 2005

2. New Zealand Dermatological Society Incorporated. Scombroid Fish Poisoning. Available at: http://dermnetnz.org/reactions/scombroid.html. Accessed January 17, 2005.

3. Otwell WS. Scombroid Poisoning. Available at: www.tidewater foodservice.com. Accessed January 18, 2005.

4. Plantz SH.Wilderness: Scombroid Poisoning. Available at: www.emedicinehealth.com/articles/27938-6.asp. Accessed January 18, 2005.

5. Moses S. Scombroid Fish Poisoning. Available at: www.fpnotebook.com/ER46.htm. Accessed January 18, 2005.

6. Noltkamper D. Toxicity, Marine–Histamine in Fish. Available at: www.emedicine.com/ped/topic1012.html. Accessed January 18, 2005.