Iannuzzi M, D'Ignazio N, Bressy L, De Sio A
Intensive Care Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy.
Minerva Anestesiol. 2007 Sep;73(9):481-3.
Scombroid fish poisoning (scombrotoxism, scombroid ichthyotoxicosis) is a food-related illness typically associated with the consumption of dark and white meat fish. Two patients presented to the emergency department. Metilprednisone 1000 mg and ranitidine 150 mg were administered initially. A large amount of crystalloids and colloids in in combination with vasoactive drugs were required to maintain normopressure. Levels of histamine and N-methylhistamine were far above the normal mean. Carboxyhemoglobin levels were also tested to exclude a superimposition of carbon monoxide intoxication. In both cases, major symptoms occurred and were treated aggressively. Early goal directed fluid therapy corrected the DO2/VO2 unbalance, due to a distributive pattern of hypovolemic impending shock, and permitted a rapid stabilisation of both patients. It is important to recognize the syndrome as an intoxication (rather than an allergic reaction) so that the source of the toxin can be identified and further cases prevented. It is also important to investigate where the fish was cooked (i.e. in an open space vs. closed space), to exclude the possibility of a concomitant carbon monoxide intoxication, which would require transfer the patient to a hospital facility equipped with a hyperbaric chamber.
鲭鱼中毒（组胺中毒、鲭鱼毒素中毒）是一种与食物相关的疾病，通常与食用深色和白色鱼肉有关。两名患者被送往急诊科。最初给予甲泼尼龙1000毫克和雷尼替丁150毫克。需要大量晶体液和胶体液并联合血管活性药物来维持正常血压。组胺和N - 甲基组胺水平远高于正常均值。还检测了碳氧血红蛋白水平以排除一氧化碳中毒的叠加情况。在这两个病例中，都出现了主要症状并进行了积极治疗。早期目标导向性液体治疗纠正了由于低血容量性即将休克的分布模式导致的氧输送/氧消耗失衡，并使两名患者迅速稳定下来。重要的是将该综合征识别为中毒（而非过敏反应），以便能够识别毒素来源并预防更多病例。调查鱼的烹饪地点（即在开放空间还是封闭空间）也很重要，以排除同时发生一氧化碳中毒的可能性，这可能需要将患者转移到配备高压氧舱的医院设施。
