Substance
Botulinum toxin

Pathology
Potent neurotoxicity produced by Clostridium botulinum; prevents release of acetylcholine by irreversibly binding to cholinergic nerve terminals.

Symptoms
Nausea, vomiting, occasional diarrhea, dysphagia, diplopia, loss of visual acuity and pupillary reflexes, profuse sweating, rapid and weak pulse, death usually caused by respiratory failure. Symptoms may present up to a week after ingestion.

Emergency Measures
Airway maintenance and ventilatory assistance, as needed. Trivalent botulism antitoxin may be administered in severe overdoses to bind free toxin, although its use often causes hypersensitivity reactions.

Comments
Even with excellent supportive care, recovery may take months to years. Common long-term sequelae include dysgeusia, dry mouth, dyspepsia, constipation, tachycardia, arthralgias, and fatigue. Botulinum antitoxin is available from the local health department or the CDC [(404) 329-2888].