Tetrodotoxin intoxication results from ingesting puffer fish or other animals containing the toxin. Clinical presentation is mainly acute motor weakness and respiratory paralysis. Death is common in the worst affected victims. Although the severity of the symptoms generally depends on the amount of toxin ingested, it may be influenced by the victim’s medical condition, as described in this report. The patient was a 52 year old uraemic woman. The uraemia was of undefined aetiology. Over the past 3 years she has received regular haemodialysis. One day both she and her husband, a healthy 55 year old man, ate a fish soup. About 4 hours after the meal she developed a headache and a lingual and circumoral tingling sensation and numbness at the distal parts of all four limbs. She was dizzy and unsteady, had difficulty in swallowing, and became very weak. She was taken to the emergency service and was placed on machine assisted ventilation as respiratory distress and cyanosis developed. Her husband remained asymptomatic throughout this time.