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Scombroid poisoning

PART A

Scombroid poisoning is a form of food poisoning. It happens when a person eats fish species containing high amounts of a chemical called histidine.

Histidine is an amino acid that naturally occurs in fish. When people do not keep the fish in a refrigerator, bacteria break down the histidine and turn it into histamine.

Histamine is responsible for the toxicity that causes scombroid poisoning, according to the American Academy of Allergy, Asthma & Immunology (AAAAI.

When people do not store the fish in a refrigerator, it results in an overgrowth of bacteria. The bacterial strains responsible for the condition produce enzymes that turn histidine into histamine.

PART B

Symptoms usually start within a few minutes to 2 hours after eating the fish, per the FDA. The initial ones resemble an allergic reaction, such as:

sweating

facial flushing

peppery taste around the throat and mouth

headache

dizziness

nausea

These initial symptoms may progress to:

facial rash

swelling

hives

short-term abdominal pain and diarrhea

The symptoms typically linger 4–6 hours and rarely last beyond 1–2 days, according to the FDA.

In the worst cases, the poisoning may cause:

blurred vision

respiratory distress

swelling of the tongue

In rare cases, the poisoning may result in death.

PART C

PART D

Many doctors suggest that induced vomiting may help remove the poison if the poisoned person is awake and alert and has recently eaten the fish (or other food) within the past 3 hours.

Oral charcoal may be used in some patients that are seen early after ingestion of large amounts of food likely containing significant amounts of scombroid poison. Some doctors recommend that the stomach should be pumped to remove foods before charcoal is administered. Moreover, patients are often given IV fluids as they may become dehydrated from vomiting.

Scombroid poisoning can be treated with diphenhydramine (Benadryl) 25 to 50 mg given orally (or initially by IV) every 6 hours and one ranitidine (Zantac) tablet twice a day as needed to reduce or stop symptoms.