• Ming-Ling Wu, Chen-Chang Yang, Jou-Fang Deng, and Kuo-Yen Wang.
• Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
• Ann Emerg Med. 2014 Dec 1;64(6):633-6.

AbstractSevere electrolyte disturbances caused by fish poisoning are rarely reported in the literature. We present an unusual outbreak of palytoxin poisoning associated with the consumption of Goldspot herring (Herklotsichthys quadrimaculatus). Four family members became ill after eating 2 species of marine fish. The presenting symptoms and signs included bitter taste, oral numbness, nausea, vomiting, abdominal pain, and hypertension, which were followed by myalgia, limb numbness, sensorimotor polyneuropathy, and abnormal cold and warm sensations. The index case manifested hyperkalemia, hyperphosphatemia, and acute kidney injury, and developed severe cardiac dysrhythmias. He died 21 hours postingestion. Palytoxin and related compounds were identified by liquid chromatography tandem mass spectrometry in one of the leftover fish. Palytoxin poisoning is rarely reported and is difficult to diagnose in the absence of laboratory confirmation. Palytoxin poisoning should be considered in patients who manifest hyperkalemia and hyperphosphatemia after the consumption of marine fish, and timely laboratory analysis should be sought.Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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