Shellfish Poisoning
                        ===================

þ Main Types of Shellfish Poisoning:
 - neurological
 - diarrheal
 - paralytic

þ Prevention
 - Most shellfish poisoning, unfortunately, is from heat-stable toxins so
   cooking doesn't help much.

þ Paralytic Shellfish Poisoning
 - The death rate from paralytic shellfish poisoning ranges from 1 -12
   percent.  No reported deaths have occurred from diarrheal or neurologic
   shellfish poisoning.
   Arnold and Norris: Shellfish Poisoning in Plantz and Adler's EMedicine
   http://www.emedicine.com/emerg/topic528.htm

þ Diarrheal Shellfish Poisoning
 - Gastroenteritis from DSP develops shortly after shellfish ingestion and
   generally lasts 1-2 days.
   [Arnold and Norris: Shellfish Poisoning in Plantz and Adler's
   EMedicine http://www.emedicine.com/emerg/topic528.htm]

þ Hypotensive Shellfish Poisoning
 - I've seen one case where a patient basically became hypotensive and
   tachycardic from shellfish poisoning but no other symptoms (Baltimore about
   1985, oysters, Paul Roman of the NJ EMT Registry was the one who had it).

þ Amnestic Shellfish Poisoning
 - A singular outbreak in Canada in 1987 occurred in which Canadians exposed
   to the shellfish containing the causative toxin developed gastroenteritis,
   headache and short-term memory loss.  A few developed severe cognitive
   dysfunction, seizures or coma, and the death rate was 3%.
   Arnold and Norris: Shellfish Poisoning in Plantz and Adler's EMedicine
   http://www.emedicine.com/emerg/topic528.htm
 - Also reported from simple exposure to the relevant dinoflagellates in
   tidewater Maryland in 1998 (NPR Morning Edition, 5/4/98).

þ When are shellfish toxic?
 - Toxic shellfish outbreaks occur when toxic dinoflagellates proliferate in
   the water and are eaten by shellfish.  This tends to occur in warmer
   weather, so the mnemonic is that shellfish are least likely to be toxic if
   harvested in a month that contains the letter "r".

þ Callistin Shellfish Poisoning
 - associated with the Japanese Callista clam.
 - syndrome of cholinergic crisis with muscarinic and nicotinic symptoms.
   [Arnold and Norris: Shellfish Poisoning in Plantz and Adler's
   EMedicine http://www.emedicine.com/emerg/topic528.htm]

þ Venerupin Shellfish Poisoning
 - associated with two specific Japanese lake-harvested oysters and clams.
 - occassionally feed on a toxic dinoflagellate which produces a potent
   hepatotoxin which has resulted in death from fulminant hepatic failure
   in 33% of cases to date.
   [Arnold and Norris: Shellfish Poisoning in Plantz and Adler's
   EMedicine http://www.emedicine.com/emerg/topic528.htm]