Puffer fish are notorious. Considerable delicacy in Japan (a taste adopted by some non-Japanese Foodies), they come with a side of risk: some puffer fish have the potent lethal toxins tetrodotoxin and/or saxitoxin, neurotoxins more than 1000 times the lethal potency of cyanide:
Symptoms start within 20 minutes to 2 hours after eating the toxic fish. Initial symptoms include tingling of the lips and mouth, followed by dizziness, tingling in the extremities, problems with speaking, balance, muscle weakness and paralysis, vomiting, and diarrhea. In severe intoxications, death can result from respiratory paralysis. (US FDA)
Not all puffer fish have toxin (NB: puffer fish are also called fugu, bok, blowfish, globefish, swellfish, balloonfish, or sea squab). But you can’t tell from looking at it if they are the deadly kind. So pufferfish meals have always have a little extra frisson associated with them. Part of the pleasure, I guess. You can improve your chances living to eat another meal, however, if you know the fish has been caught in an area where the fish are toxin-free or are fish that have been specially prepared to prevent the edible flesh from being contaminated with these potent toxins. This is possible because most of the toxin(s) are found in the liver, ovaries or testes, intestine or skin, so the fish meat skilled processors can prepare the fish by removing these organs in ways that prevent the rest of the fish from being contaminated. The Japanese government regulates and certifies processors and Japanese processed puffer fish meat has been exported to other countries, including the US, where a single importer sells it to restaurants.
Some puffer fish caught in the US have toxin and some don’t. Florida, for example, bans commercial and recreational fishing for puffer fish in most waters and these fish have toxin regardless of processing. North of Virginia, marine coastal puffer fish have not yet been shown to have toxin, but neither has systematic monitoring assured all are toxin free. The FDA guidance on eating puffer fish says it is OK to eat puffer fish if you know it has been properly prepared or comes from the mid-Atlantic region of the US.
Our advice is this. If you eat a puffer fish you should place yourself immediately under the care of a doctor: a psychiatrist.