Death by Fugu

Few days ago, a colleague of mine asked my help to asses a case of a young patient with no history of asthma nor heart condition in the past who was admitted due to sudden onset of difficulty of breathing. When I saw the patient, he was restless and dyspneic. History revealed that the condition started few hours after eating a puffer fish. According to the family of the patient, there were 12 of them who ate the fish and two died before reaching the hospital.

Despite of the risk, we Filipinos still love to eat puffer fish or butete as we commonly call it in tagalog. In fact, I have one friend whose family likes to eats puffer fish. According to her, it taste like chicken and it is delicious.

Actually, this is the first time I encountered a patient poisoned by eating a puffer fish as far as my medical practice is concern. I never expected that puffer fish poisoning could cause instant death even if taken in small amount.

According to the NATGEO WILD, there are more than 120 species of puffer fish worldwide. Mostly are found in tropical and subtropical ocean waters, but some specie live in brackish and even in fresh water. They have long tapered bodies with bulbous head. Some wear wild marking sand colors to advertise their toxicity, while others have more muted or cryptic coloring to blend with the environment.

They range in size from the 1-inch-long dwarf or pygmy puffer to the freshwater giant puffer, which can grow to more than 2 feet in length. They are scaleless fish and usually have rough to spiky skin.

The diet of the puffer includes mostly invertebrates and algae. Poisonous puffers are believed to synthesize their deadly toxin from the bacteria in the animal they eat. Almost all puffer fish contains tetrodotoxin, a substance that makes them foul tasting and often lethal. Tetrodotoxin is deadly, up to 1,200 times more poisonous than cyanide.

The tetrodotoxin kills by paralyzing the nerves. Victims can't move or breath but they are fully conscious until their lungs fail. The only way to save victims is to use a respirator to breath for them until the toxin ware off.

Amazingly the meat of the puffer fish is considered a delicacy in Japan. They call it fugu and it is extremely expensive and only prepared by trained, licensed chefs who know that one bad cut means almost death for a customer. Indeed this is an ultimate food taboo.