ER trip after treating for flatworms...

[lutz123]

I wanted to share an experience that hopefully will remind everyone to WEAR GLOVES...

I bought a 58 gallon established tank from someone a few weeks ago. There were 65 pounds of gorgeous Tampa Bay Saltwater live rock - teeming with critters. There is also a GSP, Pulsating Xenia, and a leather (plus the various TBS live rock anemones & a small tube coral. Unfortunately I noticed a population of flatworms growing (the rusty orange squarish ones, some tiny creamy pacman ghost looking ones, and some 1/2 inch ones that looked identical to the 3" white and brown speckled polyclad flatworm I had removed during setup). My thinking was that it would be a good idea to dose some Flatworm Exit before adding fish - may as well, right? The population wasn't too bad - it was more of a precaution rather than a need for treatment.

My instructions state that one cap doses 75 gallons so I added a little less than a capful (10ish gallons of water in the sump). I've seen instructions that say a capful for 90 gallons as well. I noticed a few of the rusty ones floating around within a few minutes so I opted to begin siphoning to reduce the risk to the snails, etc. I wasn't getting anything much so I quit after about 10 seconds. Within seconds I noticed that my thumb felt a little funny where I had plugged the end of the siphon, and my right hand as well (that was in the tank). Another 10 seconds later and I decided I need to look up Flatworm Exit sickness possibilities on Google because my heart was starting to race. 5 seconds after that I opted to grab the box in case I lost consciousness and ran for the phone to dial 911 because my heart was beating so fast I thought it was going to burst and I was beginning to feel faint. My blood pressure got extremely high, as did my heart rate. It began to come down slightly before arriving at the hospital, though I still wasn't coherent enough to ask them to call my husband. I started getting nauseous and my mouth went dry, as well as it becoming slightly harder to breathe. The symptoms gradually receded with only supportive care because no one knew what caused it. Two days later I still have slight chest pain and a queasy stomach.

I ran across a forum post today finally, after 2 days of searching, describing a 911 experience that I could have written myself, only the guy had squished a nudibranch with his fingers (I'm not sure if he knew it was one or not). I think he said the nudi had been eating his zoas. He thought it was a palytoxin reaction because it was eating zoas, but someone corrected him and said that it was simply the death of the nudi that released the toxin.

Has anyone heard of a similar experience? I'm now pretty certain that it was not directly the Flatworm Exit ingredients, but was a toxin released by something that died or was really ticked off. My symptoms were nearly identical to this guy's. FWE can kill nudis...I've never seen any in the tank, but I also know there's a gorgeous orange frilly limpet I haven't seen since setting it up (and the previous owner had never seen that or the big polyclad snail eater).

Any thoughts? (And yes, I've ordered gloves). Also, will carbon likely remove anything lurking in the tank that may send me the the ER again?

Thanks!

[100%hydrophylic]

I would have guessed it was something that you bothered rather than the medication itself..... how did you start the siphon?.......

[lutz123]

Originally Posted by 100%hydrophylic

I would have guessed it was something that you bothered rather than the medication itself..... how did you start the siphon?.......

Yeah, except that I didn't know what the medication was exactly - no ingredients listed...and I had just had my hand in the tank earlier in the day with no issues. I started it by pumping the end up and down...not by mouth.

[seapug]

What did the doctors at the ER have to say?

[100%hydrophylic]

sorry, i meant that it was probably something that the medication bothered (as you said the flatworms were floating around.) inverts can release some nasty toxins. It may have been an allergic reaction to the flatworm exit though. i find it kinda weird that such a severe reaction occurred from just having your thumb on the hose though. Im also curious as to what the ER said?

[widmer]

Yea it does sound like symptoms of a classic anaphylactic reaction ...except that it sounds like the symptoms so easily resolved. Did you get a shot of epinephrine or any other med?

I would cast my guess as well that some organism in distress released some sort of toxin. There's a lot we don't really know about reef inhabitants. The question though is whether the toxin has degraded or if its still present in the water. If it were me, I would do a few consecutive 100% water changes. But I wouldn't touch it until someone else was home in case the same thing happened again...

[lutz123]

The ER really didn't come to any definite conclusions, though they didn't think allergy because I didn't have any swelling or contact irritation. Per Poison Control's instructions, once I felt improved they kept me for a few hours and sent me home.

FWIW, here's the post I was referring to, freakishly similar to what I experienced - the speed of onset, and the heart rate/blood pressure especially. Notice he never ID'd the "nudi", and someone told him later it was likely the nudi toxin, not a zoa toxin.:

I have a small nano reef tank that I've recently set up at work. Its an 18g softy tank that I planned to showcase zooanthids in. So a few weeks ago, I purchased about 10 colonies from the logical reef, and set up the little nano for them. About two weeks ago, I noticed a small nudibranch on/in some of the zooanthids. I actually posted here about it to get an ID. I didnt want anything eating my new zooanthid colonies, and I wanted to make sure I didnt need to remove it from the tank. The ID came back as tentatively a zooanthid eater, so I just made the decision to remove them. I'd been picking them out of the tank for about the past week without any thought or worry. Today however, was a different story. I saw one of the little nudi's 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 it into the glass. The thing was about the size of a small zooanthid polyp, or about the size of a pencil ereaser. I saw a little bit of the goo inside it squeeze out, and then I brushed it off my finger in the water with my thumb, pulled my hand out and wiped it off with my towel. It only took about 5 seconds for me to realize something was wrong. I got a hot flash. I didn't think anything of it right at that second, but I sat down and turned back to my computer. About 20 seconds after that, I got another flash, and I noticed that my heart rate was starting to rise. I immediately knew something was seriously wrong. I waited another 30 seconds before I turned around and told a coworker of mine to dial 911. He gave me a questioning look, and I said that I really meant it, and so he said alright, turned around and dialed. At this point, I started to get dizzy, and my heart was really starting to ramp up. This is maybe 90 seconds after I squished the little nudi. He hung up the phone and said they were on their way, and I started to explain what happened in case I lost consciousness before the EMT's got to me. He knows a bit about my hobby, so he understood what was going on. I propped my feet up and tried to breath slow, but it was getting harder to breathe, and my heart was still going faster. The EMT's got there in about 4 minutes. I work in DC and I'm only about 2 blocks from the whitehouse, and 5 from George Washington Hospital, so it thankfully didnt take long. They came up and lifted me out of my chair, put me in an orange chair, strapped me in and got me on oxygen. They carried me out of my work, with everyone looking on of course, into the evelvator and down into the ambulance. The EMT asked me to describe 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. At this point it was about 150/80 and my heart rate was 115bpm. She laid me back, turned up the oxygen, and we headed off for the ER. It only took another 3-4 minutes to get back to the hospital. There was some traffic, so they asked me if I could walk to a wheel chair. I said I'd try, but as soon as I stood up, I collapsed. So they put me back on the stretcher, and took and extra 30 seconds to back the ambulance in to the dock. They then wheeled me into the centrel of the critical care unit. At this point, they hooked me up to another blood pressure machine. At this point it was about 10 minutes since exposure, and my blood pressure was 169/70 and my heart rate was 154bpm. They wheeled me into a big room, and hooked me up to oxygen again. Three doctors arrived and started to question me. At this point, my fingers on both hands had begun to tingle, simliar to when your hand falls asleep and you start to get blood back in it, only about twice as many pins and needles. I told them this, and I described how the tingling was moving from my fingers up my arms. The sensation made it to my elbow before it started to receed. This is about 15-20 minutes in now, and my thighs began to have a low burning sensation from the inside. This moved down my leg on the inside and back up the outside. Around 25 minutes, my legs went numb. My fingers were also numb at this point, though not to the extent that my legs were. Around the 30 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. They actually had to have me sign something at this point, and what ended up on the paper was not really recognizable as a signature. This intensified slightly for about 10 minutes, though never to the point where I was bouncing around on the bed. Just a shake that I couldnt stop. A little more than a shiver when you are really really cold. Around 40 minutes, this started to subside. They took my tempurature, and it was normal. I had another couple of hot/cold flashes, and my hands began to feel cold and clammy. They checked my breathing and heart with a stethoscope, and asked if I had any pain anywhere. I didnt. They also took my shirt up and checked me over for rashes. I didn't have any. For the next 15 minutes the hot flashes continued, but I felt like my heart was slowing down. I kept taking my own pulse to make sure my heart was still beating. At 150bpm, you can't really tell that your heart is beating, its just tripping along inside your chest, and I wanted to make sure it didn't stop or start to flutter on me. I dont know what I would have done about it, but it made me feel better. Around an hour, there was a noticable decrease in the number of flashes, and my heart was coming back down to where I could count the individual beats. They stopped constant watch over me, and my coworker and boss showed up. I was starting to feel better at this point, and I was chatting with them for maybe 20 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 layed in the critical care room for another two hours as my strength slowly came back, and things went back to normal. Around the 4 hour mark, my blood pressure was back down to 132/76 which is normal for me, and my heart rate was 86bpm. At this point, I actually felt pretty good, and asked to be discharged. They agreed and let me go. 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. To be honest, I feel ok now, a little out of it, but I think its more from stress than any risidual toxin. One important thing to note, was that even though I described the zooanthids, and the palytoxin they are known to produce, the doctors were unable to dig up any resource with any information concerning treatment or antidotes. They even called the national aquarium in baltimore for information and came up dry.

[Harry_Y]

Panic attack?

Sometimes we can get a scare and the scare gets worse, and you panic.

I got stun by anemone once (about 25 years ago) when I first got in the
hobby it scared me so bad I went to the hospital, I could feel it coming
up my arm and across my chest, yea it freaked me out pretty bad as well.

Glad to hear you are OK.

[100%hydrophylic]

well heres the steps i would take if i were you:
1.) put gloves on
2.) run crap loads of carbon
3.) rest for 2 or 3 days
4.) After a few days away from the tank, replace the carbon with more carbon and do some large water changes
5.) dont touch nudis :P.

It is my opinion that many of these dangerous toxins in our tanks are highly variable. Some individual specimens have stronger toxins than others, and some people are more susceptible to the toxins than others. you may have just gotten a pretty potent population of nudis in your tank. Well anyway, im also glad your ok after that ordeal .

[scapes]

i had flatworms at one point. i treated with FE, didn't work. flatworms came back. tried it again. didn't work.. i finally decided to get a melanarus wrasse. worked great and it's a pretty fish! i'd never trust medicine if i could buy a critter to solve the problem

[Vinny Kreyling]

I have a copy of an EMERGENCY LIST for us sw keepers.
Any one wanting one send me your email I I will forward it to you.
List ALL your critters and keep it close so if you have to go you take it with you,
& you let another know it's location if they need to take it for you.
Came from Christine Williams who has spoken on this subject.

[headless]

Originally Posted by scapes

i had flatworms at one point. I treated with fe, didn't work. Flatworms came back. Tried it again. Didn't work.. I finally decided to get a melanarus wrasse. Worked great and it's a pretty fish! I'd never trust medicine if i could buy a critter to solve the problem

+1

[Humu Humu]

Wow! That's some story. I'm glad I wore gloves when I put my zooa's in my tank last week. I think I'll pick up some think rubber gloves used for cleaning.

[RRaider]

Originally Posted by lutz123

I wanted to share an experience that hopefully will remind everyone to WEAR GLOVES...

I bought a 58 gallon established tank from someone a few weeks ago. There were 65 pounds of gorgeous Tampa Bay Saltwater live rock - teeming with critters. There is also a GSP, Pulsating Xenia, and a leather (plus the various TBS live rock anemones & a small tube coral. Unfortunately I noticed a population of flatworms growing (the rusty orange squarish ones, some tiny creamy pacman ghost looking ones, and some 1/2 inch ones that looked identical to the 3" white and brown speckled polyclad flatworm I had removed during setup). My thinking was that it would be a good idea to dose some Flatworm Exit before adding fish - may as well, right? The population wasn't too bad - it was more of a precaution rather than a need for treatment.

My instructions state that one cap doses 75 gallons so I added a little less than a capful (10ish gallons of water in the sump). I've seen instructions that say a capful for 90 gallons as well. I noticed a few of the rusty ones floating around within a few minutes so I opted to begin siphoning to reduce the risk to the snails, etc. I wasn't getting anything much so I quit after about 10 seconds. Within seconds I noticed that my thumb felt a little funny where I had plugged the end of the siphon, and my right hand as well (that was in the tank). Another 10 seconds later and I decided I need to look up Flatworm Exit sickness possibilities on Google because my heart was starting to race. 5 seconds after that I opted to grab the box in case I lost consciousness and ran for the phone to dial 911 because my heart was beating so fast I thought it was going to burst and I was beginning to feel faint. My blood pressure got extremely high, as did my heart rate. It began to come down slightly before arriving at the hospital, though I still wasn't coherent enough to ask them to call my husband. I started getting nauseous and my mouth went dry, as well as it becoming slightly harder to breathe. The symptoms gradually receded with only supportive care because no one knew what caused it. Two days later I still have slight chest pain and a queasy stomach.

I ran across a forum post today finally, after 2 days of searching, describing a 911 experience that I could have written myself, only the guy had squished a nudibranch with his fingers (I'm not sure if he knew it was one or not). I think he said the nudi had been eating his zoas. He thought it was a palytoxin reaction because it was eating zoas, but someone corrected him and said that it was simply the death of the nudi that released the toxin.

Has anyone heard of a similar experience? I'm now pretty certain that it was not directly the Flatworm Exit ingredients, but was a toxin released by something that died or was really ticked off. My symptoms were nearly identical to this guy's. FWE can kill nudis...I've never seen any in the tank, but I also know there's a gorgeous orange frilly limpet I haven't seen since setting it up (and the previous owner had never seen that or the big polyclad snail eater).

Any thoughts? (And yes, I've ordered gloves). Also, will carbon likely remove anything lurking in the tank that may send me the the ER again?

Thanks!

I would be willing to bet that the other guy did experience a palytoxin reaction. Many creatures of this type get their toxins from what they eat so while the toxin was released when he squashed the nudi it was likely palytoxin that he was poisoned with imo.

I had a large polyclad flatworm in my tank for well over a year before I ever saw it and it was huge. There is no telling what was killed or distressed enough to release that potent of a toxin into the water in your tank. Hopefully it's dead now, glad you are ok.