Dr. Johnson-Arbor 1 Chronic ciguatera poisoning: a case report. Wilderness Environ Med. 2023 Mar 2; (S1080-6032(23)00003-0) (Epub ahead of print) described an illustrative case of ciguatera fish poisoning, but we disagree on treatment. Johnson-Arbor 1 Chronic ciguatera poisoning: a case report. Wilderness Environ Med. 2023 Mar 2; (S1080-6032(23)00003-0) (Epub ahead of print) describes the evidence supporting mannitol as “minimal.” This description is subjective and misleading. In fact, mannitol is the most studied treatment for ciguatera fish poisoning (including cases involving symptoms for weeks or months). 2 Bagnis R. Spiegel A. Boutin J.P. Burucoa C. Nguyen L. Cartel J.L. et al. Evaluation of the efficacy of mannitol in the treatment of ciguatera in French Polynesia.

Med Trop. 1992; 52: 67-73

, 3 Blythe D.G. De Sylva D.P. Fleming L.E. Ayyar R.A. Baden D.G. Shrank K. Clinical experience with iv mannitol in the treatment of ciguatera.

Bull Soc Pathol Exot. 1992; 85: 425-426

, 4 Blythe D.G. Fleming L.E. Ayyar D.R. De Sylva D. Baden D. Schrank K. Mannitol therapy for acute and chronic ciguatera fish poisoning.

Memoirs Queensland Museum. 1994; 34: 465-470