RESUMEN
Puffer fish is a common form of poisoning throughout Egyptian coastal cities such as Suez city. Puffer fish contains one of the most powerful marine toxins which is called tetrodotoxin. We attract attention of health professional to toxicity of puffer fish and factors affecting the clinical picture and outcome of poisoning which will help for early diagnosis and proper management. The study was carried out nine patients with history of puffer fish ingestion transferred to General Suez Hospital. Diagnosis was made on the basis of recent dietary history and clinical presentation. All cases were clinically examined, investigated and observed from admission to discharge. All patients were treated with gastric lavage, activated charcoal and symptomatic. Accordingly to clinical grading system for tetrodotoxin toxicity, three patients had grade 1 and another three had grade 2 but, three fatal cases had grade 3 and their condition worsened and became grade 4. The onset of appearance of toxic symptoms of puffer fish poisoning was rapid. All investigations for all patients were within normal limits. Clinical manifestations of poisoning were mainly neurological, but the cardiovascular effects were not common in the majority of patients. Toxic manifestations were wide range from mild to severe according to state of preparation and clean of puffer fish. Fatal cases ate gonads and head of fish and the cause of death was respiratory failure. The factors affecting the severity and the prognosis of puffer fish toxicity are the mode or preparation, the clean and the eaten part of fish