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JKSCT : Journal of The Korean Society of Clinical Toxicology

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Respiratory Failure following Tetramine poisoning after Ingestion of Sea Snail: A Case Report
Joo Hwan Lee, Jin Wook Park, Seong Jun Hong, Jae-Cheon Jeon, Sang-Chan Jin
J Korean Soc Clin Toxicol. 2020;18(1):42-46.   Published online June 30, 2020
DOI: https://doi.org/10.22537/jksct.2020.18.1.42
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Tetramine toxicity due to sea snail ingestion is generally mild and has a good prognosis. Tetramine toxicity acts on the acetylcholine receptor, affecting the neuromuscular junction and autonomic nervous system. A 78-year-old female patient visited the emergency room with vomiting and dyspnea after eating sea snails. At the time of admission, the vital signs recorded were 140/80 mmHg-105/min-24/min-36.5℃, and 90% oxygen saturation. Arterial blood test revealed hypercapnia (pCO2 58.2 mmHg) and respiratory acidosis (pH 7.213, HCO3- 22.5 mmol/L), whereas other blood tests showed no specific findings. Due to decreased consciousness and hypoxia, endotracheal intubation and mechanical ventilation were administered to the patient. Successful weaning was accomplished after 12 hrs, and the patient was discharged without any further complications. Although tetramine toxicity rarely results in acute respiratory failure due to paralysis of the respiratory muscle, caution is required whilst treating the patient.
Two Cases of Tetramine Intoxication from Neptunea contricta
Seong You Lee, Jang Young Lee, Won Suk Lee, Won Young Sung, Sang Won Seo
J Korean Soc Clin Toxicol. 2017;15(1):65-67.   Published online June 30, 2017
DOI: https://doi.org/10.22537/jksct.2017.15.1.65
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Even though Neptunea contricta appears similar to Batilus cornutus and Rapana venosa, they are different in tetramine content which inhibits the neuronal calcium channel. Therefore, mistaking Neptunea contricta for Batilus cornutus or Rapana venosa, can result in the occurrence of toxic symptoms. Three patients developed nausea, epigastric pain, chest pain, dizziness, blurred vision, dyspnea, hypertension and tachycardia after eating Neptunea contricta. Moreover, consumption of one only piece was sufficient to cause symptoms because each Neptunea contricta has 17.3 mg of tetramine. Accordingly, care should be taken when patients are consuming more than 5 pieces because toxic symptoms such as dyspnea can occur. Moreover, correct species identification is important because the quantity of tetramine varies among sea snail species. Finally, it is important to educate people to remove the salivary glands completely before consuming Neptunea contricta.
Two Cases of Neurotoxin Tetramine Poisoning Following Ingestion of Buccinum Striatissinum
So Eun Kim, Jae Baek Lee, Young Ho Jin, Jae Chol Yoon, Si On Jo, Jeong Moon Lee, Tae Oh Jeong
J Korean Soc Clin Toxicol. 2016;14(1):66-69.   Published online June 30, 2016
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Some carnivorous gastropods have heat stable tetramine toxins in their salivary glands. This toxin is an autonomic ganglionic blocking agent that enables them to catch the prey easily by paralyzing their targets. Acute tetramine toxin poisoning in humans from eating whelks has been well described based on numerous cases, but is rare in Korea. Symptoms of tetramine poisoning include eyeball pain, blurred vision, headache, dizziness, muscular twitching, tingling of hands and feet, weakness, paralysis and sometimes collapse. Gastrointestinal symptoms, such as abdominal pain, nausea, and vomiting can also occur. However, intoxication is self-limiting and patients will usually recover in about 24 hours. Herein, we report 2 cases of tetramine poisoning after ingestion of Buccinum striatissinum as meat and soup.

JKSCT : Journal of The Korean Society of Clinical Toxicology