Associated with red tides, but can occur independently
Caused by ingestion of contaminated shellfish which harbor toxin (heat stabile) producing algae
Shellfish typically from colder waters (New England, Pacific NW, Alaska)
Paralytic shellfish poisoning
Toxins
Neurotoxic shellfish poisoning
Ciguatera
Acetaminophen toxicity
Scombroid
Ipecac toxicity
Tetrodotoxin 