What type of food poisoning is characterized by hypertension, excessive sweating, vomiting, and watery stool?

Scombroid (Histamine) Fish Poisoning

The clinical presentation of hypertension, excessive sweating, vomiting, and watery diarrhea is most consistent with scombroid (histamine) fish poisoning, though this specific constellation is not perfectly captured in the provided evidence base, which focuses primarily on bacterial toxin-mediated food poisoning.

Analysis of the Clinical Presentation

The symptom complex described—hypertension, profuse sweating, vomiting, and watery stool—suggests a toxin-mediated syndrome with autonomic/cardiovascular effects. However, the provided evidence primarily addresses bacterial food poisoning syndromes:

Bacterial Food Poisoning Syndromes from Evidence

Bacillus cereus causes two distinct syndromes 1, 2:

• Emetic type: Caused by cereulide toxin, presents with rapid onset vomiting (within 30 minutes to 6 hours), nausea, and abdominal cramps 1, 3, 4. This toxin is preformed in contaminated rice and pasta 3, 5. Notably, this syndrome does NOT typically cause hypertension or excessive sweating 4.

• Diarrheal type: Caused by proteinaceous enterotoxins (Hbl, Nhe, cytotoxin K), presents 8-16 hours after ingestion with watery diarrhea and abdominal cramps 1, 2. Again, hypertension and sweating are not characteristic features 4, 2.

Other bacterial toxins mentioned in the evidence 6:

• Botulism: Presents with neurological symptoms (diplopia, ptosis, descending paralysis), not hypertension or sweating 6
• Cholera: Causes profuse watery diarrhea and dehydration, but typically leads to hypotension (not hypertension) 6
• Staphylococcus aureus and Clostridium perfringens: Cause rapid-onset nausea, vomiting, and diarrhea without fever or cardiovascular symptoms 6

The Missing Diagnosis: Scombroid Poisoning

Based on general medical knowledge, the specific combination of hypertension, flushing/sweating, vomiting, and diarrhea is pathognomonic for scombroid (histamine) fish poisoning, which occurs from:

• Consumption of improperly stored fish (tuna, mackerel, mahi-mahi) where bacterial histidine decarboxylase converts histidine to histamine [@general medical knowledge@]
• Onset within minutes to hours after ingestion
• Histamine causes vasodilation (flushing, headache), but can paradoxically cause hypertension in some patients
• Associated symptoms: peppery taste, oral burning, urticaria, bronchospasm in severe cases
• Treatment: antihistamines (H1 and H2 blockers), supportive care

Critical Clinical Approach

Immediate assessment priorities:

• Vital signs monitoring: Document blood pressure elevation, heart rate, temperature [@general medical knowledge@]
• Cardiovascular symptoms: Assess for palpitations, chest pain, arrhythmias that may accompany severe histamine reactions [@general medical knowledge@]
• Respiratory status: Check for wheezing, dyspnea, or signs of anaphylactoid reaction [@general medical knowledge@]
• Skin examination: Look for flushing, urticaria, or erythema [@general medical knowledge@]

Diagnostic history elements:

• Food exposure within 2-6 hours: Specifically ask about fish consumption (especially dark-meat fish like tuna, mackerel) [@general medical knowledge@]
• Multiple affected individuals: Scombroid often affects multiple people eating the same meal [@general medical knowledge@]
• Peppery or metallic taste: Characteristic but not always present [@general medical knowledge@]

Management Algorithm

For suspected scombroid poisoning:

1. Immediate treatment [@general medical knowledge@]:

   • Diphenhydramine 25-50 mg IV/IM or PO
   • H2-blocker (ranitidine 50 mg IV or famotidine 20 mg IV)
   • IV fluids for dehydration from vomiting/diarrhea
   • Monitor for progression to anaphylactoid reaction

2. Severe cases with cardiovascular instability [@general medical knowledge@]:

   • Consider epinephrine if hypotension or bronchospasm develops
   • Continuous cardiac monitoring
   • ICU admission if refractory symptoms

3. Supportive care [@general medical knowledge@]:

   • Antiemetics (ondansetron) for persistent vomiting
   • Symptoms typically resolve within 12-24 hours

Common Pitfalls

• Misdiagnosing as allergic reaction: Scombroid is a toxin-mediated illness, not a true fish allergy; patients can safely eat properly stored fish in the future [@general medical knowledge@]
• Overlooking cardiovascular complications: While rare, severe cases can cause significant hypertension or hypotension requiring aggressive management [@general medical knowledge@]
• Failing to report: Scombroid outbreaks should be reported to public health authorities for food source investigation [@general medical knowledge@]