Browse
Topics & Collections
Search for a specific
disease or term
—  or  —
Learn more about ACP Smart Medicine

Dynamed

X
This content was provided by DynaMed (dynamed.ebscohost.com). For more information click here.
Last Updated: 12/6/2013  

Botulinum Toxin Poisoning

Botulinum toxin poisoning is a rare disease causing food-borne botulism, wound botulism, and infant botulism. It is considered a potential bioterror agent.

Diagnosis
  • Ask patients about details of exposure compatible with botulinum toxin poisoning, including exposure to homemade or poorly prepared commercial foods, injection drug use, or open wounds.

  • Ask patients about acute onset typical neurologic symptoms of botulinum toxin poisoning: disturbed vision, dysphagia, dysphonia, and descending bilateral weakness.

  • Ask parents of infants with possible infant botulism about lethargy, poor feeding, and constipation, especially in children with potential exposure to honey.

  • Look for cranial nerve abnormalities in patients with suspected botulinum toxin poisoning, and note that the most common presenting symptoms are dysphagia, diploplia, and dry mouth.

  • Collect body fluid samples quickly and send for toxin testing to confirm the diagnosis.

  • Consider obtaining nerve conduction studies to confirm botulinum toxin poisoning but do not delay treatment to obtain this test.

Therapy
  • Administer equine antitoxin (ABE) early in the course of botulinum toxin poisoning.

  • Administer BIG-IV early in the course of infant botulism.

  • Treat wound botulism with debridement and consider antibiotic therapy with penicillin.

  • Provide intensive supportive care and assess the need for mechanical ventilation.

  • Initiate early involvement of rehabilitation services to prevent complications.

DOI: 10.7326/d995
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Allison Brashear, MD is a consultant, received honoraria, provided expert testimony, received grants for Botox and MyoBlue. Larry E. Davis, MD, FAAN, FACP received honorarium from Merck & Co., provided expert testimony, received grants from the VA, NIH, and the University of New Mexico, received royalties from Fundamentals of Neurologic Disease. Larry E. Davis, MD, FACN, FACP No conflicts declared..
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Related Content
Annals of Internal Medicine