Poison arrows and pufferfish

Abstract

### Learning Point for Clinicians This report describes attempted suicide through subcutaneous injection of tetrodotoxin, ouabain and ryanodine, and while the method is highly unusual, it highlights common themes in the management of poisoning, in particular the recognition of ‘toxidromes’ and use of all available sources of information. An ambulance was called at 4:12 pm to a 20-year-old female found collapsed and in an agitated state. On initial assessment she was alert and orientated but retching. Blood pressure was 91/63 mmHg with a bradycardia of 40 bpm. A total of 500 mcg of atropine was administered. On arrival in the emergency department at 5:30 pm she remained alert with blood pressure of 104/55 mmHg and a heart rate of 60 bpm. Other observations were normal. The patient reported deliberately injecting tetrodotoxin subcutaneously into her abdominal wall at …