Ciguatera

• Caused by eating reef fish that have concentrated ciguatoxin
  • Barracuda and moray eel are classic
• Causes GI symptoms (nausea, vomiting, and diarrhea), quickly followed by unusual neurological signs and symptoms (hot-cold reversal, cold allodynia, paresthesias)
• Can cause bradycardia, heart block, and hypotension
• Management is supportive