Why You Should Never, Ever Mix Cocaine And Pufferfish

Only highly skilled chefs can safely prepare pufferfish. Image: Beth Swanson/Shutterstock

When a 43-year-old man turned up at a Florida hospital saying he’d had too much "blow" at home, doctors probably thought they were looking at your average mild drug overdose. Yet they were surprised to discover that the patient had in fact been eating poisonous pufferfish liver in addition to snorting cocaine, and before long had to hook him up to a ventilator and a dialysis machine as both his respiratory system and kidneys failed.

As Homer Simpson once discovered, pufferfish – also known as blowfish – is an occasionally deadly Japanese delicacy that can only be safely prepared by a handful of expert chefs. This is because the fish contains a poison called tetrodotoxin (TTX), which is primarily concentrated in the liver and gonads and must be skillfully removed from the dish, known as "fugu". According to the Centers for Disease Control and Prevention, around 50 people die in Japan each year from eating improperly prepared fugu.

As toxins go, TTX certainly isn’t one you want to mess with, with as little as 2 milligrams sometimes being sufficient to kill a person. Overall, it’s about 1,200 times more toxic than cyanide, and works by blocking the activation of nerve cells, resulting in muscle weakness, respiratory problems, and numbness. There is no antidote, and failing to treat the symptoms immediately can lead to paralysis and death.

Writing in the BMJ Case Reports, a team of doctors from the Aventura Hospital report that a local man recently turned up at ER around four hours after having eaten fugu. At that time, he was suffering from chest pains as well as vomiting, numbness in his legs, abdominal pain and muscle weakness, while also struggling to speak.

Yet the authors describe this case as more “exciting” and “interesting” than most run-of-the-mill fugu poisonings, due to the fact that the man had also been ingesting cocaine over the three previous days. This, combined with his history of high blood pressure and chronic kidney disease, led to major complications.

While in hospital, the patient’s kidney issues deteriorated and he had to be placed on a dialysis machine. He also developed pneumonia, and doctors soon had to place a tube into his airways to help him breathe.

Fortunately, most of his symptoms cleared up after about 24 hours, although he did not regain his kidney function and continues to require dialysis treatment. His grandmother, with whom he had shared the fugu (though presumably not the cocaine), was also admitted to hospital with less severe symptoms such as dizziness, but was able to recover with no major complications.

Despite their perverse excitement at witnessing this medical meltdown, the study authors end their write-up by “forewarn[ing] the public to refrain from consuming the deadly delicacy known as ‘fugu’.”

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