Table 2: Clinical grading system for TTX poisoning as described by Fukuda and Tani [30] and modified by Zimmer [31].

Clinical grading systemDescription of zombification [22]

First, “oral numbness and paraesthesia, sometimes accompanied by gastrointestinal symptoms (nausea)”Digestive disorders with vomiting.

Second, “numbness of face and other areas, advanced paraesthesia, motor paralysis of extremities, incoordination, slurred speech, but still normal reflexes.”

Third, “gross muscular incoordination, aphonia, dysphagia, dyspnoea, cyanosis, drop in blood pressure, fixed/dilated pupils, precordial pain, but victims are still conscious.”

Fourth, “severe respiratory failure and hypoxia, severe hypotension, bradycardia, cardiac arrhythmia, heart continuing to pulsate for a short period.”Pronounced breathing difficulties, pulmonary edema, hypertension, hypothermia, renal failure, and rapid weight loss.