Treatment of Food Poisoning

General Approach

• Oral hydration: Maintain fluid intake with water, oral rehydration solutions (ORS), or clear fluids
• Antiemetics (to facilitate oral hydration):
  • Ondansetron 0.15 mg/kg up to 8 mg PO
  • Metoclopramide 10 mg PO
• Antibiotics: Rarely required - most food poisoning is toxin-mediated (not active infection), so antibiotics do not hasten recovery
• Diagnostic testing is usually not indicated for routine, uncomplicated cases

By Causative Organism

1. Staphylococcus aureus

• Presentation: Abrupt onset nausea, profuse vomiting, abdominal cramps, ± diarrhea within 1-6 hours of eating; fever unusual; resolves in 24-48 hours
• Treatment: Supportive care only - rehydration, correct electrolyte imbalances (metabolic alkalosis from vomiting may occur); no specific therapy available
• Sleisenger & Fordtran's GI and Liver Disease, p. 2219

2. Clostridium perfringens (Type A)

• Presentation: Watery diarrhea, severe abdominal cramping, ± vomiting; onset 8-24 hours after ingestion; fever and chills usually absent; resolves within 24 hours
• Treatment: Supportive - no specific treatment required. Rare fatal cases in debilitated patients due to dehydration, so IV fluids may be needed
• Sleisenger & Fordtran's GI and Liver Disease, p. 2218

3. Bacillus cereus

4. Botulism (Clostridium botulinum)

• Botulinum antitoxin is the only specific treatment; it prevents further progression of paralysis but does not reverse existing paralysis - must be given early
• BabyBIG (botulism immune globulin, human-derived) is the first-line treatment for infant botulism types A and B
• Heptavalent botulinum antitoxin (BAT) - FDA-licensed for adult and pediatric non-infant botulism
• Supportive care includes mechanical ventilation if respiratory muscles are paralyzed
• Harrison's Principles of Internal Medicine 22E, p. 1037; Red Book 2021, p. 2807

Fish & Shellfish Poisoning

Scombroid (Histamine) Fish Poisoning

• Presentation: Flushing, urticaria, erythematous rash, pruritus, palpitations, headache, diarrhea within 20-30 minutes of eating dark-meat fish (tuna, mahi mahi, mackerel); mimics allergic reaction; usually resolves within 12 hours
• Treatment: Antihistamines (H1-blockers ± H2-blockers); supportive care
• Sleisenger & Fordtran's GI and Liver Disease, p. 2223; ROSEN's Emergency Medicine

Ciguatera Fish Poisoning

• Presentation: GI symptoms (nausea, vomiting, diarrhea) 3-6 hours post-ingestion, followed by neurologic symptoms (paresthesias, temperature reversal - hot feels cold, nerve palsies) and cardiovascular symptoms (bradycardia, hypotension)
• Treatment: Supportive; IV mannitol may be helpful in severe neurologic cases; no antidote available
• Sleisenger & Fordtran's GI and Liver Disease, p. 2223

Tetrodotoxin (Puffer Fish) Poisoning

• Presentation: Paresthesias of lips/tongue, extremities, then ascending paralysis, potentially fatal respiratory failure
• Treatment: Supportive - mechanical ventilation if respiratory compromise occurs; no antidote; symptoms may resolve over days if patient survives
• Sleisenger & Fordtran's GI and Liver Disease

When to Seek Hospital Care / Admit

• Signs of severe dehydration (tachycardia, hypotension, decreased urine output, altered mental status)
• Neurologic symptoms (suggests botulism, ciguatera, tetrodotoxin, or paralytic shellfish poisoning)
• High-risk patients: immunocompromised, liver disease, extremes of age, pregnancy
• Symptoms lasting >72 hours or worsening
• Bloody diarrhea with fever (suggests invasive bacterial infection, not pure food poisoning - may need antibiotics)
• Suspected botulism (contact local health department for antitoxin immediately)

When Antibiotics ARE Indicated

Prevention (Brief)

• Proper refrigeration (<4°C / 40°F) and cooking temperatures
• Avoid cross-contamination between raw and cooked foods
• Wash hands thoroughly before food handling
• Report suspected outbreaks to local health departments (Salmonella, Shigella, STEC, norovirus, and hepatitis A are notifiable diseases)
• ROSEN's Emergency Medicine, p. 1315; Sleisenger & Fordtran's GI and Liver Disease, Ch. 111