Does seafood ingestion with vomiting and diarrhea require more than supportive care?

From the Guidelines

Seafood ingestion causing vomiting and diarrhea often requires only supportive care, but specific treatments may be necessary depending on the cause. For most cases of seafood-related gastroenteritis, treatment focuses on preventing dehydration with oral rehydration solutions (like Pedialyte or homemade solutions with 1 teaspoon salt, 8 teaspoons sugar in 1 liter of water) and rest, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1. However, certain seafood illnesses require additional intervention. Some key points to consider in the management of seafood-related gastroenteritis include:

• The use of oral rehydration solutions to prevent dehydration, with the recommendation to use reduced osmolarity oral rehydration solutions (ORS) as the first-line therapy for mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.
• The potential need for additional interventions, such as antihistamines for ciguatera or scombroid poisoning, or antibiotics for severe bacterial infections like Vibrio.
• The importance of seeking immediate medical attention if symptoms include difficulty breathing, severe abdominal pain, bloody diarrhea, neurological symptoms, or if symptoms persist beyond 72 hours.
• The specific treatment depends on identifying the toxin or pathogen involved, which is determined by the type of seafood consumed, symptom timing, and clinical presentation. It is also important to note that the management of infectious diarrhea has been credited with saving millions of lives, and that oral rehydration has been recommended by the World Health Organization as the first line of rehydration 1. Additionally, the 2017 IDSA guidelines recommend that patients with mild to moderate dehydration should receive ORS until clinical dehydration is corrected, and that maintenance fluids should be administered to replace ongoing losses in stools until diarrhea and vomiting are resolved 1. Overall, the management of seafood-related gastroenteritis requires a careful consideration of the underlying cause and the severity of symptoms, as well as the use of evidence-based treatments to prevent dehydration and promote recovery.

From the Research

Seafood Ingestion with Vomiting and Diarrhea

• The primary concern with seafood ingestion is the risk of foodborne illnesses, which can be caused by viral, bacterial, or parasitic agents 2.
• Symptoms such as vomiting and diarrhea can be associated with various seafood-related infections, including those caused by Vibrio parahaemolyticus 3 and scombroid fish poisoning 4.
• Treatment of viral gastroenteritis, which can be caused by seafood ingestion, focuses on correcting dehydration and electrolyte imbalances, with supportive care being the primary approach 5.
• Fluid therapy is essential in patients with vomiting and diarrhea to correct hypovolemia, dehydration, acid-base imbalance, and serum electrolyte abnormalities 6.

Supportive Care

• Supportive care, including fluid replacement and electrolyte management, is often sufficient for managing symptoms of seafood-related illnesses 5, 6.
• In most cases, seafood-related infections are self-limiting, and symptoms resolve with supportive care alone 2, 3, 4.
• However, certain cases may require more intensive treatment, such as hospitalization, especially if the patient has underlying disorders or severe symptoms 2, 4.

Specific Considerations

• Consumption of raw or undercooked seafood increases the risk of infection, and people with underlying disorders, particularly liver disease, are more susceptible to infection 2.
• Scombroid fish poisoning can cause significant hypotension, necessitating close monitoring and potentially more aggressive treatment 4.
• Vibrio parahaemolyticus infections can be severe and may require specific treatment, such as antibiotics, in certain cases 3.