{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T18:38:18Z","timestamp":1758393498072,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,5,24]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:p>We report the case of a 43-year-old African American man with a history of hypertension and chronic kidney disease presenting with hypertensive emergency and bulbar paralysis in a descending fashion, which ultimately led to acute respiratory failure. He ingested pufferfish liver during the preceding 4\u2009hours prior to presentation, as well as canned foods and cocaine over the prior 3\u2009days. He had a complicated hospital course requiring intubation and mechanical ventilation, as well as the development of acute respiratory distress syndrome and acute renal failure requiring haemodialysis. This case exemplifies the classic manifestations of tetrodotoxin poisoning with some unique overlapping features, in the setting of an interesting social history.<\/jats:p>","DOI":"10.1136\/bcr-2019-229272","type":"journal-article","created":{"date-parts":[[2019,6,8]],"date-time":"2019-06-08T05:59:01Z","timestamp":1559973541000},"page":"e229272","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Blow: a case of pufferfish intoxication in South Florida"],"prefix":"10.1136","volume":"12","author":[{"given":"Patricia","family":"Almeida","sequence":"first","affiliation":[{"name":"Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raiko","family":"Diaz","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Ferrer","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,6,7]]},"reference":[{"key":"2025082703331234000_12.6.e229272.1","unstructured":"Centers for Disease Control and Prevention (CDC. Tetrodotoxin poisoning associated with eating puffer fish transported from Japan--California, 1996. MMWR. Morbidity and mortality weekly report. 1996;45:389."},{"key":"2025082703331234000_12.6.e229272.2","doi-asserted-by":"crossref","first-page":"6384","DOI":"10.3390\/md13106384","article-title":"Tetrodotoxin, an extremely potent marine neurotoxin: distribution, toxicity, origin and therapeutical uses","volume":"13","author":"Lago","year":"2015","journal-title":"Mar Drugs"},{"key":"2025082703331234000_12.6.e229272.3","unstructured":"Taken A . Tetrodotoxin poisoning outbreak from imported dried puffer fish. Minneapolis, Minnesota, 2014."},{"key":"2025082703331234000_12.6.e229272.4","doi-asserted-by":"publisher","DOI":"10.3390\/toxins6020693"},{"key":"2025082703331234000_12.6.e229272.5","first-page":"830","article-title":"Tetrodotoxin poisoning: a clinical analysis, role of neostigmine and short-term outcome of 53 cases","volume":"48","author":"Chowdhury","year":"2007","journal-title":"Singapore Med J"},{"key":"2025082703331234000_12.6.e229272.6","doi-asserted-by":"publisher","DOI":"10.3390\/md20080011"},{"key":"2025082703331234000_12.6.e229272.7","doi-asserted-by":"crossref","first-page":"13","DOI":"10.3109\/15563650.2014.980581","article-title":"Is neostigmine effective in severe pufferfish-associated tetrodotoxin poisoning?","volume":"53","author":"Liu","year":"2015","journal-title":"Clin Toxicol"},{"key":"2025082703331234000_12.6.e229272.8","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2010.10-0168"},{"key":"2025082703331234000_12.6.e229272.9","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s13149-014-0340-2","article-title":"Family tetrodotoxin poisoning in Reunion Island (Southwest Indian Ocean) following the consumption of Lagocephalus sceleratus (Pufferfish)","volume":"107","author":"Puech","year":"2014","journal-title":"Bulletin de la Soci\u00e9t\u00e9 de pathologie exotique"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-229272","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:33:17Z","timestamp":1756290797000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-229272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6]]},"references-count":9,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2019,6,7]]},"published-print":{"date-parts":[[2019,6]]}},"alternative-id":["10.1136\/bcr-2019-229272"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-229272","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,6]]}}}