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Richard J. Geller, MD; Neal L. Benowitz, MD

Arch Intern Med. 1992;152(10):2131-2133.

Abstract
Purpose.—
The purpose of this study was to investigate the pathophysiology of persistent orthostatic hypotension in a patient with ciguatera fish poisoning.

Methods.—
A patient who became ill and who developed prolonged and symptomatic orthostatic hypotension with ciguatera fish poisoning after eating barracuda is described. Studies of autonomic function included measurements of plasma catecholamine levels in the supine and standing positions, and pressor responses to infusions of norepinephrine, atropine, and propranolol.

Results.—
Volume depletion was excluded as a cause for hypotension. Our patient showed low plasma catecholamine levels and marked pressor hypersensitivity to norepinephrine infusion. Hypotension and bradycardia were reversed by atropine infusion. The heart rate freed from autonomic influences, ie, after atropine plus propranolol infusion, was normal.

Conclusions.—
In ciguatera fish poisoning, orthostatic hypotension appears to be a result of both parasympathetic excess and sympathetic failure.

(Arch Intern Med. 1992;152:2131-2133)

Author Affiliations
From the Northern California Bay Area Poison Control Center (Drs Geller and Benowitz), the Clinical Pharmacology Unit of the Medical Service, San Francisco (Calif) General Hospital Medical Center (Dr Benowitz), and the Department of Medicine, University of California, San Francisco (Dr Benowitz), and the Fresno Regional Poison Control Center, Fresno (Calif) Community Hospital and Medical Center (Dr Geller).

Footnotes
Accepted for publication February 21, 1992.

Reprint requests to 1220 E Indianapolis, Fresno, CA 93704 (Dr Geller).

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