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Symptoms of ciguatera fish poisoning begin within an hour of eating and include diarrhea, vomiting, abdominal pain, paresthesias, pain and weakness of the lower extremities, and bradycardia. Distortion of temperature sensation, bizarre tastes, and "aching teeth" are frequently reported. Complete recovery within a few weeks is the usual course. Severe cases with coma and respiratory arrest within 24 hours of ingestion have been reported. [CCDM, p. 247] Other symptoms may include pruritis, headache, myalgia, reversal of hot/cold sensations, and facial pain. [Merck Manual, p. 3064] Heart abnormalities include bradycardia, hypotension, T wave abnormalities on EKG. Toxin most commonly found in large reef fish (grouper, red snapper, amberjack, and barracuda). [Foodborne Illnesses. MMWR. 4/16/04] Poisoning has also been reported after eating parrotfish, surgeon fish, moray eel, sea bass, and sturgeon. [CDC Travel, p. 92] Other findings are aphonia, fatigue, tremor, ataxia, vertigo, and arthralgias. [Cecil, p. 699]