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Severe scombroid poisoning and life-threatening hypotension
  1. Shalika Basnayake Katugaha1,
  2. Andrea Christine Carter1,
  3. Shashank Desai1 and
  4. Pelayia Soto2
  1. 1Inova Fairfax Medical Campus, Falls Church, Virginia, USA
  2. 2National Capital Poison Center, Washington, DC, USA
  1. Correspondence to Dr Shalika Basnayake Katugaha; skb1078{at}


Scombroid fish poisoning (SFP), the most common fish-related illness worldwide, is a histamine response caused by the heat stable toxin histamine. A healthy 48-year-old woman and co-author of this paper developed palpitations, tachycardia and hypotension 10 min after a tuna steak dinner. She subsequently developed numbness of her face, flushing, conjunctival erythema, abdominal pain, nausea, vomiting, diarrhoea, headache and chest pain. Her ECG revealed tachycardia with ST depression. Her hypotension did not respond to fluid resuscitation, and she required phenylephrine. Based on exposure history, clinical syndrome, exclusion of other diseases and consultation with poison control, a diagnosis of scombroid poisoning was established. The state health department was notified. The patient was weaned off vasopressors, dosed famotidine and discharged 43 hours after fish ingestion with no symptoms and normal ECG. SFP is an often misdiagnosed and underreported illness with the potential to cause life-threatening hypotension.

  • cardiovascular medicine
  • resuscitation
  • adult intensive care
  • medical management
  • toxicology

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  • Contributors All authors contributed greatly to this work. SBK and PS drafted the initial manuscript. SBK is the ID consultant involved in the case and PS the toxicologist at Poison Control. It was edited thoroughly by the patient and SD. SD, the cardiologist in the case, specifically edited the cardiology/intensive care unit aspects.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SK is currently employed by GlaxoSmithKline. She remains affiliated with Inova Fairfax Hospital, and the case is from when she was in practice at Inova Fairfax Hospital. Her work at GSK in vaccine research in no way is a competing interest as pertains to this case report about scombroid.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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