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Puffer poisoning usually results from consumption of incorrectly prepared puffers soup, “chiri” or occasionally from raw puffers meat, “sashimi fugu.” While chiri is much more likely to cause death, sashimi fugu often causes intoxication, light-headedness, and numbness of the lips, and is often eaten for this reason. Puffers (tetrodotoxin) poisoning will cause deadening of the tongue and lips, dizziness, and vomiting. These are followed by numbness and prickling over the body, rapid heart rate, decreased blood pressure, and muscle paralysis. Death results from suffocation as diaphragm muscles are paralyzed. Patients who live longer than 24 hours are expected to survive, although the poison can cause comas lasting several days. Many people report being fully conscious during the entirety of the coma, and can often remember everything that was said while they were supposedly unconscious. In Voodoo, puffers poison must be ingested by the victim for the black magic of creating “zombies,” most likely because of the pseudocomatose effect.[6]

Treatment consists of supportive care and intestinal decontamination with gastric lavage and activated charcoal. Case reports suggest that anticholinesterases such as edrophonium may be effective.

Saxitoxin, the cause of PSP (paralytic shellfish poisoning, red tide), can also be found in puffers. Cases of neurologic symptoms, including numbness and tingling of the lips and mouth, have been reported to arise rapidly after the consumption of puffers caught in the area of Titusville, Florida. These symptoms are generally resolved within hours to days, although one affected individual required intubation for 72 hours. As a result of such cases, Florida banned the harvesting of puffers from certain bodies of water.

A drug called Tectin that is derived from tetrodotoxin is being developed as a potent pain reliever. Administered in very small quantities it can bring relief to those suffering from intense chronic pain, such as that experienced by some cancer patients. Other uses, such as helping opiate addicts through withdrawal, are also being studied.

 The Tetraodontidae is a family of primarily marine and estuarine fish. The family includes many familiar species which are variously called puffers, balloonfish, blowfish, bubblefish, globefish, swellfish, toadfish, and toadies.[1] They are morphologically similar to the closely related porcupinefish, which have large conspicuous spines (unlike the small, almost sandpaper-like spines of Tetraodontidae). The scientific name, Tetraodontidae, refers to the four large teeth, fused into an upper and lower plate, which are used for crushing the shells of crustaceans and mollusks, their natural prey.

The skin and certain internal organs of many Tetraodontidae are highly toxic to humans, but nevertheless the meat of some species is considered a delicacy in both Japan (as fugu) and Korea (as boh-guh).

The Tetraodontidae contains at least 121 species of puffers in 19 genera.[2] They are most diverse in the tropics and relatively uncommon in the temperate zone and completely absent from cold waters. Puffers are mostly found in coastal regions though some are oceanic (e.g., Lagocephalus lagocephalus) or live in the deep sea (e.g., Sphoeroides pachygaster). A large number of puffers are found in brackish and fresh waters: at least 39 marine species enter brackish or freshwater to feed or breed (e.g., Arothron hispidus), and a further 28 species are completely freshwater fish in distribution and never enter the sea (e.g., Colomesus asellus).[3]

Tetrodotoxin is a powerful neurotoxin that can cause death in nearly 60% of the humans that ingest it. A human only has to ingest a few milligrams of the toxin for a fatal reaction to occur. Once consumed, the toxin blocks the sodium channels in the nervous tissues, ultimately paralyzing the muscle tissue. Curiously, the toxin seems not to be synthesized by the fish itself, but by bacteria associated with the fish. The fish has a mutation in its own sodium channels which makes it resistant to the effect of the toxin.