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S O D I U M A N D S O D I U M C H A N N E L S. S o d i u m a n d S o d i u m C h a n n e l s. FUGU. It’s the only delicacy forbidden to be served to the Emperor of Japanese One of few fish that can close their eyes Genome sequenced.

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S O D I U M A N D

S O D I U M C H A N N E L S


S o d i u m a n d S o d i u m C h a n n e l s

FUGU

  • It’s the only delicacy forbidden to be served

  • to the Emperor of Japanese

  • One of few fish that can close their eyes

  • Genome sequenced


S o d i u m a n d S o d i u m C h a n n e l s

CLINICAL SYMPTOMS

First stage:

Lip and tongue numbness and tingling (paresthesias)

Facial and extremity paresthesias

Second stage:

Rapidly ascending paralysis

Nausea and vomiting

Final stage:

Cardiac dysfunction, CNS dysfunction, and ultimately respiratory failure

TREATMENT

None – no drug that will reverse the effects of tetrodotoxin poisoning

Supportive ABCs

Intubate, IVs to support circulatory collapse, gastric lavage with charcoal

OUTCOME

50-60% mortality (those who survive do so without any side effects)


S o d i u m a n d S o d i u m C h a n n e l s

TETRODOTOXIN

Produced by bacteria: Pseudoalteromonas haloplanktis tetradonis

Concentrated in the liver, gonads, and skin spines of the fugu

through the action of a specific binding protein

Muscle is free of toxin and can be eaten

Toxin is thermo-stable


S o d i u m a n d S o d i u m C h a n n e l s

TETRODOTOXIN

All the clinical effects result from blockade of the voltage gated Na+ channel

Can not cross the Blood-Brain-Barrier

Affects the brain through a break in the BBB: the area postrema

Neurons directly in the vicinity of the area

postrema are responsible for respiratory

control, cardiovascular tone, consciousness


S o d i u m a n d S o d i u m C h a n n e l s

tetrodotoxin

Why don’t the puffer fishdye from their

own toxin?


S o d i u m a n d S o d i u m C h a n n e l s

SODIUM HOMEOSTASIS

Complex - controlled primarily by the kidneys and the CNS

Normal conc. = 135 – 145 mM

Things can wrong and Na+ conc. can drop well below normal levels

(vomiting) or rise well above the normal conc. (dehydration)

Goal is to normalize serum Na+


S o d i u m a n d S o d i u m C h a n n e l s

PSYCHOGENIC POLYDIPSIA

Non-physiologic need to drink  hyponatremia

Serum Na+< 120 mM

Goal is to normalize serum Na+


S o d i u m a n d S o d i u m C h a n n e l s

CENTRAL PONTINE MYELINOLYSIS

Normal Sagital MRI



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