Prolonged Tetramine Poisoning Caused by Ingestion of Gastropods in Patient with End‒stage Renal Disease： A Case Report

Abstract

A 71‒year‒old male on maintenance hemodialysis for end‒stage renal disease was referred to our hospital complaining of nausea and limb weakness, which developed within 1 h of consuming gastropods that he had purchased from a local grocery store and cooked himself without removal of the salivary gland at home. A physical examination revealed neurological abnormalities, including dysarthria, diplopia, and limb weakness. However, acute intracranial lesions were not observed. Based on the patient’s clinical course and non‒specific systemic symptoms, he was diagnosed with tetramine poisoning. The symptoms persisted after admission, but they showed marked improvement during hemodialysis, performed 13 hours after the reported ingestion. The symptoms subsequently resolved completely. Tetramine, which exists in the salivary glands of gastropods, is mostly excreted by the kidneys. Therefore, patients with severe renal impairment have a higher risk of prolonged and severe poisoning due to reduced tetramine clearance. Tetramine is a small‒molecule compound with low‒level plasma protein binding, making it highly removable by hemodialysis. Therefore, in patients with severe renal impairment who have a history of gastropod consumption and present with these symptoms, it is important to suspect tetramine poisoning and promptly initiate hemodialysis therapy.