• Journal of Food Hygiene and Safety
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• v.18 no.3
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• pp.133-138
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• 2003

The data on outbreaks of puffer fish poisoning during 1991 to 2002 in Korea were gathered from press reports, and characterized information collected. During the period, a total of 32 outbreaks of puffer fish poisoning was reported. These outbreaks caused 111 persons to become poisoning, among the cases 30 persons were fatal. The mean case fatality rate was 27.0%, and most of deaths (93.3%) were the male of above 29 years old. Patient number of below 4 persons per a poisoning accident occupied 75.0% of total outbreaks; 65.8% of total cases; and 66.7% of total deaths) was occurred in the months, November through January. Most of puffer fish poisoning (75.0% of total outbreaks; 68.5% of total cases; and 73.3% of total deaths) were found along the south coastal area of Korea, including Busan, Gyeongsangnam-do, Jeollanam-do and Jeju-do. Over than 80% of puffer fish poisoning outbreaks occurred at fishing boat and home where privately made food was cause, and outbreaks in restaurants accounted for 15.6%. Most commonly implicated foods were Guk, boiled soup with puffer fish meat and spices.

• Journal of The Korean Society of Clinical Toxicology
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• v.9 no.2
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• pp.95-100
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• 2011

Purpose: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. Methods: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients' electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. Results: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. Conclusion: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.

• Journal of Pharmacopuncture
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• v.3 no.2
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• pp.1-25
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• 2000

We were trying to study the validity of Puffer fish's poison(Tetrodotoxin- TTX) to make a traditional Korean Medical treatment. The following conclusions were made after literary studies. 1. The first record of the puffer fish dates back 2000 years ago in the Chinese text Book of Mountain and Sea and other texts from the similar period. 2. Puffer fish's poison IS known as tetrodotoxin which is an amino perhydroquinazoline compound. It has a chemical formula of $C_{11}H_{17}N_3O_8$ in the hemiacetal structure and has the molecular weight of 319. 3. Tetrodotoxin (TTX) plays a role as potent neurotransmitter blocker by blocking the $Na^+$ -gate channel which hinders the influx of $Na^+$ ion into the cell. 4. Symptoms of the puffer fish poisoning ranges from blunted sense in the lips and tongue, occasional vomiting in the first degree to sudden descending of the blood pressure, apnea, and other critical conditions in the fourth degree. Intoxication of the puffer fish poison progresses at a rapid pace as death may occur after an hour and half up to eight hours in maximum. Typical death occurs after four to six hours. 5. Ways to treat the puffer fish poisoning include gastric irrigation, induce vomiting, purgation, intravenous fluid injection, and correcting electrolytic imbalance and acidosis. In cases of dyspnea, apply oxygen inhalation and conduct artificial respiration. 6. Tetrodotoxin (TTX) may be applied in treating brain disorders, ocular pain, excess pain in the large intestine and ileum, and relieving tension of the skeletal museles, neuralgia, rheumatism, arthritis, and etc. 7. In terms of Oriental medicine, the puffer fish poison has characteristics of sweet, warm, and poisonous. It's known efficacies are to tonify weakness, dispel damp, benefit the lower back, relieve hemorrhoid, kills parasites, remove edema, and so forth. And the puffer fish eggs processed with ginger are said to be effective against tuberculosis and lung cancer, thus, it's validity must be investigated and further research should be followed.

• Fisheries and Aquatic Sciences
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• v.24 no.11
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• pp.360-369
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• 2021

Paralytic shellfish toxins (PSTs) and tetrodotoxin (TTX) are neurotoxins that display pharmacological activity that is similar to that of specific sodium channel blockers; they are the principle toxins involved in shellfish and puffer fish poisoning. In Korea, puffer fish is a very popular seafood, and several cases of accidental poisoning by TTX have been reported. Therefore, it is necessary to determine whether puffer fish poisoning incidents are caused by PSTs or by TTX. In this study, we used mouse bioassay (MBA) and liquid chromatograph-tandem mass spectrometry (LC-MS/MS) to determine the presence of PSTs and TTX in puffer fish from an area near Mireuk-do, Tong-Yeong on the southern coast of Korea from January through March, 2014. The toxicity of PSTs and TTX extracts prepared from three organs of each specimen was analyzed by MBA. Most of the extracts killed mice with typical signs of TTX and PSTs. The LC-MS/MS analysis of seven specimens of Takifugu pardalis and Takifugu niphobles, each divided into muscles, intestines, and liver, were examined for TTX. In T. pardalis, the TTX levels were within the range of 1.3-1.6 ㎍/g in the muscles, 18.8-49.8 ㎍/g in the intestines, and 23.3-96.8 ㎍/g in the liver. In T. niphobles, the TTX levels were within the range of 2.0-4.5 ㎍/g in the muscles, 23.9-71.5 ㎍/g in the intestines, and 28.1-114.8 ㎍/g in the liver. Additionally, the toxicity profile of the detected PSTs revealed that dcGTX3 was the major component in T. pardalis and T. niphobles. When PSTs were calculated as saxitoxin equivalents the levels were all less than 0.5 ㎍/g, which is below the permitted maximum standard of 0.8 ㎍/g. These findings indicate that the toxicity of T. pardalis and T. niphobles from the southern coast of Korea is due mainly to TTX and that PSTs do not exert an effect.

• Journal of The Korean Society of Clinical Toxicology
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• v.12 no.2
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• pp.46-53
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• 2014

Purpose: We conducted this study in order to determine clinical features and prognostic factors in adults with acute tetrodotoxin (TTX) poisoning caused by ingestion of puffer fish. Methods: In this retrospective study, 107 patients were diagnosed with TTX poisoning. The subjects were divided into two groups according to duration of treatment; Group I, patients were discharged within 48 hours (n=76, 71.0%), Group II patients were discharged after more than 48 hours (n=31, 29.0%). Group II was subsequently divided into two subgroups [IIa (n=12, 11.2%), IIb (n=19, 17.8%)] according to the need for mechanical ventilation support. Results: In multivariable logistic regression analysis, the predictors of the need for treatment over 48 hours were dizziness (odds ratio [OR], 4.72; 95% confidence intervals [CI], 1.59-12.83), time interval between onset of symptom and ingestion (OR, 0.56; 95% CI, 0.16-0.97), $PaCO_2$<35 mmHg (OR, 8.37; 95% CI, 2.37-23.59). In addition, predictors of the need for mechanical ventilation were a time interval between onset of symptoms and ingestion (OR, 0.54; 95% CI, 0.11-0.96) and $PaCO_2$<35 mmHg (OR, 5.65; 95% CI, 1.96-18.66). Conclusion: Overall, dizziness, time interval between onset of symptoms and ingestion, ${\Delta}DBP$ and $PaCO_2$<35 mmHg predict the need for treatment over 48 hours, time interval between onset of symptoms and ingestion and $PaCO_2$<35 mmHg predict the need for mechanical ventilation support after acute TTX poisoning.

• The Korean Journal of Physiology
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• v.10 no.1
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• pp.41-48
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• 1976

Tetrodotoxin (TTX) is the purified active principle responsible for tetrodon (Puffer-fish) poisoning which has long been known in the Orient. The pharmacological actions of TTX have been rather extensively investigated. Two of the most prominent effects of intravenousely administered TTX are severe hypotension and respiratory paralysis resulting from its depressant actions on tissues. This depressant actions of TTX in turn result from the selective inhibition of sodium-carrying mechanism which is essential to generation of the action potential. TTX differs from local anesthetics in that it does not affect potassium conductance. Although the mechanism of the hypotensive action of TTX remains a subject of controversy, most investigator agree that TTX-induced hypotension is caused by alteration in the blood vessels rather than the heart. Not only the study on the effects of TTX on cardiac function is meager but the results of reported works are often contradictory. The present study was undertaken to investigate the effect of TTX on the electrocardiogram of the rabbit and to compare them with well known electrocardiographical characteristics found in digitalis and quinidine intoxicated animals. The results obtained from the present study are summarized as follows. 1. No changes were found in P-R interval and QRS duration after i.v. administration of $1.0\;{\mu}g/kg\;to\;1.5\;{\mu}g/kg$ TTX to the animals. It is obvious that there were no conduction disturbance between atria and ventricles as well as in the ventricular tissue. 2. In $1.0\;{\mu}g/kg$ TTX group, S-T interval and T-P segment were not changed whereas marked changes were observed in $1.5\;{\mu}g/kg$ TTX group. 3. The first and second degree A-V blocks appeared in the $2.0\;{\mu}g/kg$ TTX group. 4. TTX differs from digitalis and quinidine in that it does not cause S-T interval depression and T-wave inversion. In contrast with digitalis, TTX caused Q-T interval prolongation.