Pediatric emergency medicine trisk 3105 3105
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The dinoflagellate Gonyaulax is responsible for elaborating the toxin (saxitoxin)
that causes paralytic shellfish poisoning (PSP). The name “red tide” is based on
the characteristic red pigment of the Gonyaulax. PSP appears in large bloom
between the months of May and October and is found primarily along the eastern
seaboard (although blooms have increased across the world in more recent years
and may be found on either U.S. coast). The animals that ingest and concentrate
this toxin are primarily bivalve shellfish, including mussels, clams, oysters, and
uncommonly, scallops. The toxin, saxitoxin, is capable of reversibly binding
neuronal sodium channels, resulting in depolarization disturbances. The toxin is
heat stable.
After ingestion of contaminated shellfish, patients quickly develop nausea and
vomiting, followed by generalized paresthesias, cranial nerve disturbances, and
weakness. Severe intoxications may lead to cardiorespiratory failure.
Treatment of PSP is supportive. Patients may require ventilatory support until
the intoxication resolves over hours to days.
