Palytoxin works by targeting the sodium-potassium pump protein by binding to the molecule, locking it in a position where it allows passive transport of both the sodium and potassium ions. This destroys the ion gradient that is essential for most cells. Because palytoxin affects every cell in the body, the symptoms are very different for the different ways of exposure. The most common way of exposure in humans is oral. The onset of symptoms in a palytoxin poisoning is rapid, and death usually follows quickly.
If you suspect you have been exposed ....
.... then it would be a very good idea to print out the following and take it with you to the emergency department, Palytoxin: essential data.
- Care should be taken when handling and propagating corals with species that contain palytoxin.
- Never handle with open cuts or wounds on the hands, preferably use gloves when handling and always wear eye/face protection when propagating.
- Do not wipe eyes, mouth or nose prior to washing hands after handling.
- Never leave pieces of zoanthids from the family Zoanthidae laying around where children or pets may come into contact.
Reported / Documented Cases of Poisoning
- A 32-year-old male was admitted to the surgical emergency department in the University Hospital of Heidelberg, Germany, 20 h after injuring three fingers of his right hand on a zoanthid colony while cleaning his sea water aquarium at home. The patient complained of shivering, myalgia and general weakness of all extremities with increasing intensity, which had started 2 h after the injury. About 16 h later, he had collapsed at his workplace exhibiting dizziness, speech disturbance and glassy eyes.
While handling the corals without protection (no gloves), the patient was exposed to highly dangerous concentrations of the toxin, which eventually entered to body through the skin wounds causing general poisoning symptoms. 
- One of the first documented reports, although it is only anecdotally covered in the literature, occurred during the first collections of P. toxica in Hawaii in the early 1960’s (Moore et al., 1982). While collecting zoanthid colonies in shallow rock pools, with bare hands and feet resulting in small cuts and abrasions, a researcher experienced dizziness, nausea, headache, increasing malaise, and discomfort to the hands and feet requiring medical attention. Treatment was supportive and some effects lasted for one week. 
- This case involved a man in Virginia (USA) with presumed inhalational toxin exposure from attempting to remove a colony of medium sized green/brown zoanthids from a rock by pouring boiling water over the infested portion. The zoanthids had been growing in the aquarium for 3 years and had arrived as a contaminant with live rock. During this process, the patient inhaled steam and immediately stopped after noticing a foul odor. The zoanthid containing rock was retained in a separate aquarium. Within 20 min, the patient experienced rhinorrhea and coughing at which time the patient took an antihistamine believing the symptoms to be caused by seasonal allergies. Within 4 h post exposure, the patient experienced difficulty breathing and lightheadedness which progressed to severe fits of coughing and chest pain. At this point the patient was admitted to a local hospital. Upon admission, ECG was normal. The patient was administered an anti-inflammatory corticosteroid and pain medication. It is not known if CPK levels were tested. After 15 h of observation the patient was released and prescribed an inhaled steroid treatment and cough suppressant. A follow-up examination by a pulmonary specialist 2 weeks post exposure diagnosed the patient with asthma-like symptoms of bronchial inflammation and bronchoconstriction. The inhaled steroid treatment was continued until symptoms subsided, approximately 1 month post exposure.
- The second case reported from Deeds and Schwartz (2010) involved a man in Georgia, USA with dermal exposure resulting in symptoms of chest pain, lightheadedness, and weakness and numbness of the left arm, requiring hospitalization. The patient’s left hand had contacted what was described by the patient as a red and pink zoanthid recently purchased from a local fish store. Upon admission, the patient’s heart rate and blood pressure were elevated (116 bpm and 184/96 mmHg, respectively). The patient showed elevated CPK levels (patient 508 IU/l; normal range 22–269 IU/l) suggestive of mild rhabdomyolysis. Additional testing demonstrated normal serum electrolytes, complete blood count, urinalysis, and coagulation factors. An ECG demonstrated sinus tachycardia without ischemia. Left arm numbness and chest pain subsided over the next 4 h after admission. Eight hours after admission, the repeat CPK level was 425 IU/l with all other serum biomarkers remaining normal. After an additional 8 h, CPK levels were still elevated (415 IU/l). Despite his resolving symptoms, the decision was made to admit and observe the patient in the telemetry unit overnight. The patient was discharged the following day.
- Palytoxin and You: How and Why to Avoid a Deadly Zoanthid Toxin by Nicholas Violand - Tropical Fish Magazine
- Palytoxin: Don't Frag Under the Influence by James Passantino - Reefs Magazine
- Steamed Palythoas send well-informed aquarist to the emergency room, nearly to the grave by Jake Adams
- The Palytoxin Afternoon - Watch out for Zoanthids! by Miguel Tolosa
- Palytoxin, the World's Second Deadliest Poison, Possibly Available at Your LFS by Shane Graber - Advanced Aquarist's Online Magazine
- Palytoxin: essential data - important information to present to a treating doctor.
- (http://dx.doi.org/10.1126/science.172.3982.495): Moore, R., Scheuer , P., Palytoxin: a new marine toxin from a coelenterate, Science AAAS, 172(982), (1971), 495-498.
- (Delbeek Sprung 1997): Delbeek, J.C., Sprung, J., The reef aquarium: a comprehensive guide to the identification and care of tropical marine invertebrates, Ricordea Publishing: Coconut Grove, 1997.
- (http://dx.doi.org/10.1016/j.toxicon.2008.03.009): Hoffmann, K., Hermanns-Clausen, M., Buhl, C., Büchler, M.W., Schemmer, P., Mebs, D. and Kauferstein, S., A case of palytoxin poisoning due to contact with zoanthid corals through a skin injury, Toxicon, 51(8) (2008) 1535-1537.
- (http://en.wikipedia.org/wiki/Main_Page): Wikipedia contributors, Wikipedia, The Free Encyclopedia, Retrieved: 26 July 2011, wikipedia:Palytoxin.
- (http://dx.doi.org/10.1016/j.toxicon.2011.01.005): Tubaro, A, Durando, P., Del Favero, G., Ansaldi, F., Icardi, G., Deeds, J.R. and Sosa, S., Case definitions for human poisonings postulated to palytoxins exposure, Toxicon, 57(3) (2011) 478-495.