Tetrodotoxin: Biotoxin

Colorless crystalline solid that darkens when heated above 428°F (220°C).

Tetrodotoxin is an extremely potent poison (toxin) found mainly in the liver and sex organs (gonads) of some fish, such as puffer fish, globefish, and toadfish (order Tetraodontiformes) and in some amphibian, octopus, and shellfish species. Human poisonings occur when the flesh and/or organs of the fish are improperly prepared and eaten. Tetrodotoxin interferes with the transmission of signals from nerves to muscles and causes an increasing paralysis of the muscles of the body. Tetrodotoxin poisoning can be fatal.

• Indoor Air: Because the natural source of tetrodotoxin is from living organisms, and manufacturing tetrodotoxin artificially in appreciable quantities is extremely difficult, dissemination through indoor air is unlikely.
• Water: Because the natural source of tetrodotoxin is from living organisms, and manufacturing tetrodotoxin artificially in appreciable quantities is extremely difficult, dissemination through water is unlikely.
• Food: Exposure to tetrodotoxin usually occurs through eating improperly prepared fish or possibly through contamination of other food products.
• Outdoor Air: Because the natural source of tetrodotoxin is from living organisms, and manufacturing tetrodotoxin artificially in appreciable quantities is extremely difficult, dissemination through outdoor air is unlikely.
• Agricultural: Because tetrodotoxin is unlikely to be disseminated through indoor or outdoor air, it is also unlikely to be disseminated through agricultural products.

Exposure occurs due to ingestion of fish or other food containing tetrodotoxin.

The following are general recommendations for hazardous material exposure. However, it is unlikely that tetrodotoxin will require this amount of protection.
First Responders should use a NIOSH-certified Chemical, Biological, Radiological, Nuclear (CBRN) Self Contained Breathing Apparatus (SCBA) with a Level A protective suit when entering an area with an unknown contaminant or when entering an area where the concentration of the contaminant is unknown. Level A protection should be used until monitoring results confirm the contaminant and the concentration of the contaminant.
NOTE: Safe use of protective clothing and equipment requires specific skills developed through training and experience.

Select when the greatest level of skin, respiratory, and eye protection is required. This is the maximum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than the AEGL-2.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A Totally-Encapsulating Chemical Protective (TECP) suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, and a hard hat worn under the TECP suit are optional items.

Select when the highest level of respiratory protection is necessary but a lesser level of skin protection is required. This is the minimum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than AEGL-2. It differs from Level A in that it incorporates a non-encapsulating, splash-protective, chemical-resistant splash suit that provides Level A protection against liquids but is not airtight.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the respiratory protection criteria factors for using Air Purifying Respirators (APR) or Powered Air Purifying Respirators (PAPR) are met. This level is appropriate when decontaminating patient/victims.

• A NIOSH-certified CBRN tight-fitting APR with a canister-type gas mask or CBRN PAPR for air levels greater than AEGL-2.
• A NIOSH-certified CBRN PAPR with a loose-fitting face-piece, hood, or helmet and a filter or a combination organic vapor, acid gas, and particulate cartridge/filter combination or a continuous flow respirator for air levels greater than AEGL-1.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Escape mask, face shield, coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the concentration is below the appropriate occupational exposure limit or less than AEGL-1 for the stated duration times.

• Limited to coveralls or other work clothes, boots, and gloves.

• Not established/determined

• Not established/determined

• Not established/determined

• Not applicable

• Not established/determined

• OSHA: Not established/determined
• NIOSH: Not established/determined

• AIR MATRIX
  No references were identified for this sampling matrix for this agent.
• OTHER
  Hayashida M, Hayakawa H, Wada K, Yamada T, Nihira M, Ohno Y [in press]. A column-switching LC/MS/ESI method for detecting tetrodotoxin and Aconitum alkaloids in serum. Leg Med. Available online 16 January 2003.Horie M, Kobayashi S, Shimizu N, Nakazawa H [2002]. Determination of tetrodotoxin in puffer-fish by liquid chromatography-electrospray ionization mass spectrometry. Analyst 127(6):755-759.

  Kreuzer MP, Pravda M, O’Sullivan CK, Guilbault GC [2002]. Novel electrochemical immunosensors for seafood toxin analysis. Toxicon 40(9):1267-1274.

• SOIL MATRIX
  No references were identified for this sampling matrix for this agent.
• SURFACES
  No references were identified for this sampling matrix for this agent.
• WATER
  No references were identified for this sampling matrix for this agent.

Tetrodotoxin poisoning may either have rapid onset (10 to 45 minutes) or delayed onset (generally within 3 to 6 hours but rarely longer). Death may occur as early as 20 minutes, or as late as 24 hours, after exposure; but it usually occurs within the first 4 to 8 hours. Patient/victims who live through the acute intoxication in the first 24 hours usually recover without residual deficits. Symptoms may last for several days and recovery takes days to occur.

Tetrodotoxin interferes with the transmission of signals from nerves to muscles by blocking sodium channels. This results in rapid weakening and paralysis of muscles, including those of the respiratory tract, which can lead to respiratory arrest and death.

• Not established/determined

• First stage: Numbness and sensation of prickling and tingling (paresthesia) of the lips and tongue, followed by facial and extremity paresthesias and numbness, headache, sensations of lightness or floating, profuse sweating (diaphoresis), dizziness, salivation (ptyalism), nausea, vomiting (emesis), diarrhea, abdominal (epigastric) pain, difficulty moving (motor dysfunction), weakness (malaise), and speech difficulties.
• Second stage: Increasing paralysis, first in the extremities, then in the rest of the body, and finally in the respiratory muscles; difficulty breathing or shortness of breath (dyspnea); abnormal heart rhythms (cardiac dysrhythmias or arrhythmia); abnormally low blood pressure (hypotension); fixed and dilated pupils (mydriasis); coma; seizures; respiratory arrest; and death.

• Not established/determined

• Not established/determined

The following are general recommendations for hazardous material exposure. However, it is unlikely that tetrodotoxin will require extensive decontamination, as its toxicity is primarily through individual ingestion. Off gassing is not believed to be a hazard. Safe disposal of the contaminated food and cleaning of all food preparation surfaces and utensils with soap and water should be sufficient.
The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and effectively. Care should be taken during decontamination, because absorbed agent can be released from clothing and skin as a gas. Your Incident Commander will provide you with decontaminants specific for the agent released or the agent believed to have been released.

The following are recommendations to protect the first responders from the release area:

• Position the decontamination corridor upwind and uphill of the hot zone.
• The warm zone should include two decontamination corridors. One decontamination corridor is used to enter the warm zone and the other for exiting the warm zone into the cold zone. The decontamination zone for exiting should be upwind and uphill from the zone used to enter.
• Decontamination area workers should wear appropriate PPE. See the PPE section of this card for detailed information.
• A solution of detergent and water (which should have a pH value of at least 8 but should not exceed a pH value of 10.5) should be available for use in decontamination procedures. Soft brushes should be available to remove contamination from the PPE.
• Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE.

The following methods can be used to decontaminate an individual:

• Decontamination of First Responder:
  • Begin washing PPE of the first responder using soap and water solution and a soft brush. Always move in a downward motion (from head to toe). Make sure to get into all areas, especially folds in the clothing. Wash and rinse (using cold or warm water) until the contaminant is thoroughly removed.
  • Remove PPE by rolling downward (from head to toe) and avoid pulling PPE off over the head. Remove the SCBA after other PPE has been removed.
  • Place all PPE in labeled durable 6-mil polyethylene bags.
• Decontamination of Patient/Victim:
  • Remove the patient/victim from the contaminated area and into the decontamination corridor.
  • Remove all clothing (at least down to their undergarments) and place the clothing in a labeled durable 6-mil polyethylene bag.
  • Thoroughly wash and rinse (using cold or warm water) the contaminated skin of the patient/victim using a soap and water solution. Be careful not to break the patient/victim’s skin during the decontamination process, and cover all open wounds.
  • Cover the patient/victim to prevent shock and loss of body heat.
  • Move the patient/victim to an area where emergency medical treatment can be provided.

Initial treatment is primarily supportive.

There is no antidote for tetrodotoxin toxicity.

• Not established/determined

• Remove the patient/victim from the source of exposure.
• Prevent others from eating until the source of tetrodotoxin exposure can be ascertained, in order to avoid more casualties.
• Do not induce vomiting (emesis).
• Administer supplemental oxygen and assist ventilation as needed.
• Seek medical attention immediately.

• Not established/determined

• Not established/determined

If the patient/victim can be rapidly transported to an emergency department following decontamination, stomach pumping (gastric lavage) may be considered after the airway has been secured. Gastric lavage is recommended only after ingestion of a life-threatening amount of tetrodotoxin and only if it can be done shortly after ingestion (generally within 1 hour). The risk of worsening injury to the lining of the gastrointestinal (GI) tract must be considered. Heart function should be monitored, and the patient/victim should be evaluated for low blood pressure (hypotension), abnormal heart rhythms (dysrhythmias), and reduced respiratory function (respiratory depression). The patient/victim should be evaluated for low blood sugar (hypoglycemia), electrolyte disturbances, and decreased oxygen supply to the tissues (hypoxia).

Not established/determined

Information is unavailable about the carcinogenicity, developmental toxicity, or reproductive toxicity from chronic or repeated exposure to tetrodotoxin.

• Consult with the Incident Commander regarding the agent dispersed, dissemination method, level of PPE required, location, geographic complications (if any), and the approximate number of remains.
• Coordinate responsibilities and prepare to enter the scene as part of the evaluation team along with the FBI HazMat Technician, local law enforcement evidence technician, and other relevant personnel.
• Begin tracking remains using waterproof tags.

• Wear PPE until all remains are deemed free of contamination.
• Establish a preliminary (holding) morgue.
• Gather evidence, and place it in a clearly labeled impervious container. Hand any evidence over to the FBI.
• Remove and tag personal effects.
• Perform a thorough external evaluation and a preliminary identification check.
• See the Decontamination section for decontamination procedures.
• Decontaminate remains before they are removed from the incident site.

The following methods can be used to decontaminate the environment/spillage disposal:

• Do not touch or walk through the spilled agent if at all possible. However, if you must, personnel should wear the appropriate PPE during environmental decontamination. See the PPE section of this card for detailed information.
• Keep combustibles (e.g., wood, paper, and oil) away from the spilled agent.
• Use water spray to reduce vapors or divert vapor cloud drift. Avoid allowing water runoff to contact the spilled agent.
• Do not direct water at the spill or the source of the leak.
• Stop the leak if it is possible to do so without risk to personnel, and turn leaking containers so that gas rather than liquid escapes.
• Prevent entry into waterways, sewers, basements, or confined areas.
• Isolate the area until gas has dispersed.
• Ventilate the area.

Agents can seep into the crevices of equipment making it dangerous to handle. The following methods can be used to decontaminate equipment:

• Not established/determined