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Ciguatera fish poisoning is endemic in the Caribbean and Pacific islands, and is the most frequently reported seafood-related disease in the United States. The toxin, which originates in a protozoan and is passed up the food chain, is not inactivated by cooking. It can cause complications ranging from diarrhea to coma, and can be fatal.
These investigators from the Marshall Islands hypothesized that cerebral edema is involved in the most serious cases of poisoning, and they administered mannitol to 24 such patients. All patients had marked improvement of neuromuscular complications within minutes of receiving mannitol (and slower resolution of gastrointestinal manifestations). Two patients in coma and one in shock also had full recoveries wi…