Chelonitoxin Poisoning and Breastfeeding

Summary of use during lactation

Chelonitoxism is caused by eating sea turtle meat contaminated with chelonitoxins, which are thought to accumulate from the environment without affecting the turtle. Initially, gastrointestinal symptoms occur, followed by neurologic, hepatic and renal toxicity. Breastfed infants have been adversely affected by maternal poisoning, including some deaths. Mothers suspected of having chelonitoxin poisoning should not breastfeed until they have recovered.

Drug levels in milk and infant serum

Maternal Levels. Relevant published information was not found as of the revision date. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

One poisoning incident occurred after ingestion of hawksbill turtle, Eretmochelys imbricata, at a family gathering on a remote island in Micronesia. Two adults and 4 children aged 2 to 4 years died from the poisoning before reaching the hospital. Two of the four infants who died were breastfed after maternal ingestion, one had received only breastmilk and another who had also been given a small amount of turtle meat.[1] Another cluster of poisonings from eating meat from the same species of sea turtle occurred in western Madagascar and affected 76 victims. Seven lactating women and their 7 infants were poisoned. None of the mothers died, but 4 of the infants died, including 1 who was exclusively breastfed. Infant symptoms consisted of hypotonia, dyspnea and coma. Five of the mothers had discontinued nursing their infants because of symptoms, but 2 of their infants died despite this precaution. There are several other reports of breastfed infant deaths in the literature.[2,3]

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. Kirschner RI, Jacobitz KL. Multiple fatalities following ingestion of sea turtle meat. Clin Toxicol 2011;49:571. doi:10.3109/15563650.2011.598695
2. Rasamimanana NG, Randrianandrasana JC, Andrianarimanana KD, et al. Chelonitoxism in breast-fed child: Cases in Mahajanga, Madagascar. Med Sante Trop 2017;27:329-32.28947412 PubMed
3. Rasamimanana NG, Andrianirina ZZ, Razafilalaina FM, et al. Collective poisoning from sea turtle consumption in Mahajanga Madagascar, May 2014. Med Sante Trop 2017;27:56-61.28406418 PubMed