Forensic

NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE

Bad Fish: Human Anatomy

and Physiology Edition

by

James A. Hewlett

Science and Technology Department

Finger Lakes Community College

Part I – Poisoned!

One evening during a recent trip to Indonesia, Dr. Marshall Westwood from the Montana Technical Institute sat down

to a meal of pufferfish and rice. Within an hour of returning to his hotel room, Dr. Westwood felt numbness in his lips

and tongue, which quickly spread to his face and neck. Before he could call the front desk, he began to feel pains in his

stomach and throat, which produced feelings of nausea and eventually severe vomiting.

Fearing that he had eaten some “bad fish” for dinner, Dr. Westwood called a local hospital to describe his condition.

The numbness in his lips and face made it almost impossible for him to communicate, but the hospital staff managed

to at least understand the address he gave them and they sent an ambulance in response. As Dr. Westwood was rushed

to the hospital, his breathing became increasingly difficult.

Doctor’s Notes

The patient presented in the ED with severe headache, diaphoresis, motor dysfunction, paresthesias, nausea, and

an ascending paralysis that spread to the upper body, arms, face, and head. The patient was cyanotic and was

hypoventilating. Within 30 minutes of presenting in the ED, Dr. Westwood developed bradycardia with a BP of

90/50. Atropine was administered in response to the bradycardia. IV hydration, gastric lavage, and activated charcoal

followed a presumptive diagnosis of tetrodotoxin poisoning based on the clinical presentation in the ED. Five hours

after intervention, the following vitals were noted:

• BP 125/79

• HR 78bpm

• Oxygen saturation: 97% on room air

Follow-up

Within a few hours, Dr. Westwood’s condition improved

and he was on his way to a full recovery. After discussing

his case with his physician, he learned that he had

probably been the victim of a pufferfish...