Botulism with respiratory insufficiency requiring extra corporeal carbon dioxide removal

Despite a low incidence of botulism in the industrialized world some cases occasionally occur in Germany after eating contaminated food. Because botul ism is rarely seen, most physicians are unfamiliar with its early recogniti on and treatment. However, immediate intensive care treatment is important. We report the case of a previously healthy 54-year-old female who develope d signs of botulism after eating vacuum packed smoked fish and developed se vere respiratory insufficiency with difficult carbon dioxide elimination in the days following.