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Here we reported a case of severe puffer fish poisoning with prolonged respiratory muscle paralysis, hypotension and temporary complete blindness for which we were able to measure blood and urine TTX concentrations for 4 days after ingestion. Serum TTX concentrations at 23,41, and 63 hours after arrival were 89,17, and 7.7ng/mL, respectively, with only a trace amount at 87 hours. Urine TTX concentrations at 23,41,63 and 87 hours after arrival were 723,443,60, and 6.8 ng/mL, respectively.
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