Critical Tetramine Poisoning after Sea Snail Ingestion in a Patient on Peritoneal Dialysis: A Case Report

Tetramine in gastropods can cause poisoning symptoms with various side effects. Most of these symptoms are mild and spontaneously resolved due to the rapid excretion of tetramine through the kidneys; however, patients with kidney dysfunction can present severe symptoms. A 48-year-old woman with end-stage kidney disease due to diabetic nephropathy and undergoing peritoneal dialysis (PD) visited our emergency department (ED) with complaints of general weakness, vomiting, and shortness of breath after ingesting some sea snails. On ED arrival, she was in a respiratory failure state; therefore, invasive mechanical ventilation was immediately initiated. Chest radiography showed diffuse severe pulmonary edema and her vital signs fluctuated; thus, continuous renal replacement therapy (CRRT) was initiated at the intensive care unit to treat tetramine intoxication and control volume status. Her condition gradually improved, and she was successfully weaned from mechanical ventilation on the 5th day of admission and moved to the general ward on the 10th day. CRRT was switched to PD. She fully recovered and was discharged on the 15th day of admission. Therefore, clinicians should explain the risk associated with gastropod ingestion to patients with kidney dysfunction and recognize that the clinical course of tetramine toxicity can be critical.