Myoglobinuric acute renal failure following cardioversion in a boxfish poisoning patient

Abstract

Trunkfish are unique in that their bodies are enclosed in a hard box‐like shell, and include boxfish, cowfish and turretfish. Members of the family Ostraciidae secrete an ichthyotoxic mucus from their skin when stressed or disturbed [1]. Fish exposed to this secretion develop irritability, gasping, quiescence, decreased rate of opercular movement, loss of equilibrium and locomotion, sporadic convulsions and death [2]. Rhabdomyolysis, a destructive skeletal muscle disease, can be caused by crush injury and other non‐traumatic circumstances, e.g. alcoholism, viral infection, metabolic disorders, myopathies, drugs, etc. [3,4]. It is usually associated with elevated muscle enzymes in the serum and myoglobinuria. We report the case of a patient who suffered boxfish (Ostracion meleagris meleagris) poisoning, resulting in a cardiopulmonary catastrophe. Although cardiopulmonary resuscitation (CPR) was successful, the patient developed myoglobinuric acute renal failure as a result of the CPR electrical countershocks.