Five persons including two children died after eating puffer fish recently. This tragic incidence occurred in Sylhet district. This type of episode is not very uncommon in Bangladesh. Every year quite a few lives are claimed by the ingestion of puffer fish in our country.
Puffer fish is a cheap fish containing a neurotoxin that causes paralysis of the diaphragm and causes death. Signs and symptoms of toxicity start within 30 minutes after ingestion of puffer fish. Nausea, vomiting, numbness, paresthesia (tingling sensation) and ultimately paralysis of the respiratory system ensure death if not treated properly. Tetrodotoxin is the poison responsible for this serious situation. It is sometimes more toxic than cyanide.
Puffer fish is a popular delicacy in Japan but they do not have any such history of poisoning. If the liver, gonads, salivary glands and skin of puffer fish are being removed before cooking, toxicity is unlikely.
If any toxicity develops, victims have to be transferred to tertiary hospital immediately as they may require ventilatory support. Mass awareness is needed to avoid such unexpected death. Avoidance of taking such fish should be advocated.
The author is a Professor of Paediatrics at Community Based Medical College, Mymensingh.