Blow: A Case of Pufferfish Intoxication in South Florida.


East Florida


Aventura Hospital and Medical Center

Document Type

Case Report

Publication Date



respiration - artificial, neuromuscular diseases, toxicology, tetraodontiformes, tetrodotoxin, marine toxins, pufferfish, emergency medicine


Biological Factors | Heterocyclic Compounds | Medicine and Health Sciences | Pulmonology


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 hours prior to presentation, as well as canned foods and cocaine over the prior 3 days. 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.

Publisher or Conference

BMJ Case Reports