East Tennessee Reef Club - Articles - pH - Toxic Nudibranchs
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      Toxic Nudibranchs    
      By Brian Robak
Cheverly, Maryland

Reprinted with permission from MASNA
This article appeared in the MASNA Volume 12, Issue 3, Summer 2003 Newsletter
   
           
     

First I'd like to say that I'm okay. Second, I hope that by reading this story, some of you might avoid a similar experience.

I have a nano-reef tank that I've recently set up at work. It's an 18-gallon softy tank where I planned to showcase zoanthids. I purchased about ten zoanthid colonies from the Logical Reef, and set up the little tank for them. About two weeks ago I

noticed small nudibranchs on some of the zoanthids. I posted a message at the Reef Central bulletin board in the hopes of getting a positive ID on the nudibranch. I didn't want anything eating my new zoanthid colonies, but I wanted to make sure that removing them from the tank was the right course of action. The ID did come back as a "probable zoanthid eater", so I began to remove them I'd been picking them out of the tank for almost a week without any thought or worry. Today however was a different story.

I saw one of the little nudis on the front glass and I thought that instead of pulling it out I'd just squish it against the glass. So I reached in and with my index finger, I pressed the nudibranch into the glass. The slug was about the size of a small zoanthid polyp, or roughly the size of a pencil eraser A little of the goo that was inside the nudibranch ended up on my index finger when I squished it so I rubbed my finger against my thumb in the water pulled my hand out of the tank and wiped it off with a towel.

It only took about five seconds for me to realize something was wrong. I got a hot flash. I didn't think much of it at the time and I sat down and turned on my computer. About twenty seconds later, I had another flash, and I noticed that my heart rate was starting to increase. That's when I knew something was seriously wrong. I waited an-other thirty seconds before I turned around and told a coworker of mine to dial 911. He gave me a questioning look. I told him that I was serious, so he said "Alright", and turned around and dialed. I started to feel dizzy, and my heart was really starting to race. This was maybe ninety seconds after I squished the little nudibranch.

My coworker hung up the phone and said that help was on the way. I explained to him what had happened in case I lost consciousness before the EMTs got to me. He knows a bit about my hobby, so he understood what I was telling him. I then propped my feet up and tried to slow my breathing. It was getting harder and harder to breathe, and I could feel my heart rate increasing.

The EMTs arrived in about four minutes. My office in Washington DC is two blocks from the White House, and five blocks from George Washington Hospital, so thankfully it didn't take long for the EMTs to get to me. They came and lifted me out of my office chair, put me in a transport chair, strapped me in and gave me oxygen. They carried me out of my office, with everyone looking on, of course, into the elevator and down into the ambulance. The EMT asked me to de-scribe what was happening, so I told her I was having trouble breathing, my heart was racing and I was dizzy. She took my blood pressure. It read 150/80 and my heart rate was 115bpm. She changed me to a reclining position, turned up the oxygen, and we headed for the hospital emergency room.

It only took another three or four minutes to get to the hospital. There was some traffic at the emergency room entrance, so the EMT asked me if I could walk to a wheel chair. I said I'd try. but as soon as I stood up, I collapsed. They had to put be back on the stretcher, and took an extra thirty seconds to back the ambulance in to the dock. After being removed from the ambulance I was wheeled directly to the critical care unit. The hospital staff hooked me up to a blood pressure machine. Ten minutes had elapsed since my exposure to the nudibranch and my blood pressure was 169/70 and my heart rate was 154bpm.

They transferred me to another room, and put me back on oxygen. Three doctors arrived and started asking me questions. My fingers on both hands had started tingling, similar to the feeling when your hand "falls asleep" and you just start to get blood back into it, only twice as many pins and needles. I explained the feeling to the doctors, and described how the tingling was moving from my fingers up my arms. The sensation made it to my elbow before it started to lessen.

Fifteen to twenty minutes after exposure I began experiencing a low burning sensation in my thighs. The burning sensation moved down the inside of my legs and back up on the outside of my legs. At the twenty-five minute mark, my legs were numb. My fingers were also numb, but not to the same extent as my legs.

At the thirty minute mark, I started to shake. Not a violent movie-style shake, but a low tremble in my thighs and hands. I could not control it. The doctors needed me to sign a release form in order to give me medication, but what ended up on the paper was not really recognizable as my signature due to the shaking in my hands. The trembling intensified over the course of ten minutes, although it never got bad enough that I was bouncing around on the bed. It was really little more than a shiver like when you are really, really cold, but I couldn't stop it.

Forty minutes after exposure, the shaking started to subside. The nurse took my temperature, and it was normal. I had another couple of hot and cold flashes, and my hands began to feel cold and clammy. The doctor checked my lungs and heart with a stethoscope, and asked if I had any pain. I didn't. The doctor pulled up my shirt and checked for rashes. There were none. For the next fifteen minutes the hot flashes continued, but I could feel my heart starting to slow down. I kept taking my own pulse to make sure my heart was still beating. At 150bpm, I couldn't make out the individual beats of my heart, it was just tripping along inside my chest, and I wanted to make sure it didn't stop or start fluttering. I don't know what I would have done if it had, but somehow it made me feel better to monitor it.

Sixty minutes after exposure, there was a notice-able decrease in the number of hot flashes, and my heart had come back down to the point I could count the individual beats. The hospital staff were no longer monitoring me continuously, and my coworker and boss showed up at the hospital. I was just starting to feel better at this point, and I chatted with them for twenty minutes. It seemed like the worst was over, so my boss went back to work, and my buddy stayed with me.

He sat with me for about an hour until another doctor came in. He checked all my reflexes, asked me a couple of questions and then left. I got up to go to the bathroom, and was able to walk down the hall without too much trouble, though I was still dizzy and felt very weak.

I lay in the critical care room for another two hours as my strength slowly came back. and systems went back to normal. Around the four-hour mark, my blood pressure was back down to 132/76, which is normal for me, and my heart rate was 86bpm. I was actually feeling pretty good, and asked to be discharged. The doctor agreed and let me go home.

Diagnosis; Toxin Exposure of an unknown nature.

I'm supposed to take it easy this evening and if anything funny starts to happen, call 911 again. Honestly, I feel okay now, a little "out of it", but I think that's more from the stress than residual toxin.

One important thing to note was that even though I had described the zoanthids, and the palytoxin they are known to produce to the doctors, they were unable to find any information concerning treatment or antidotes. The hospital even called the National Aquarium in Baltimore for information and came up dry. As I was leaving the hospital, I logged one of their computers onto Reef Central and showed them the palytoxin discussions. The hospital staff was amazed. They filed the information for future use.

It's 9:20pm. I've been out of the emergency room for three hours. I guess what I want to say is, that despite the beauty of our hobby, there are inherent risks and unknown dangers. I won't stop keeping aquariums because of this incident. If anything, I've just been given a deeper respect for the creatures that come out of our oceans. But please, be aware, and be careful. After six years of uneventful reef keeping, I've come to love this hobby, and I thought I knew what was going on and had it all under control. I was put in my place today. It just goes to show you that we still all have so much to learn, and we have to be careful about how we learn it.