Carp bile poisoning: diagnosis and active resuscitation treatment

2021-07-29 12:30 AM

Signs of acute renal failure appear very soon, soon after having digestive disorders, patients begin to urinate less and then turn to anuria after 1 to 2 days, sometimes anuria after 6 to 8 hours

Usually, fish bile poisoning or drifting fish, carp occurs when people believe that drinking fish bile cure some diseases or promote health. People often swallow the whole gall bladder with water, wine, or mixed with wine, honey. The bigger the fish, the more severe the poisoning.

The main toxin is a toxic 27C alcohol called 5-a cyprinol.

Definite diagnosis

Ask the sick

The patient has taken fish bile.

Clinical symptoms

Digestive disorders:

As the first manifestations, 2-3 hours after swallowing bile, appear:

Nausea, vomiting.

Severe abdominal pain.

Then diarrhea, sometimes with bleeding.

At the same time, there are systemic signs: the patient is very tired, body aches, bedridden, dizziness, sweating, little urination.

Acute renal failure:

Signs of acute renal failure appear very soon, immediately after having digestive disorders, patients begin to urinate less and then turn to anuria after 1-2 days, sometimes anuria after 6-8 hours.

If poisoning is mild: on the third and fourth day, the urine appears more and more every day. Oliguria acute renal failure changed to urine form and fortunately, the patient was able to recover without special management measures.

If the poisoning is severe: the signs of acute kidney failure are getting worse day by day, urea, creatinine, and blood potassium gradually increase. Water and electrolyte disorders: from the initial state of hypovolemia to excess fluid, weight gain, edema, hyponatremia. Transformation. If the patient does not die, the anuria phase can last 1-2 weeks, then turn to polyuria, kidney function gradually recovers.

Acute hepatitis:

Can be discreet or obvious.

The skin and mucous membranes are gradually yellow, and the liver is enlarged.

Rarely, acute liver failure.

Blood tests: urea, blood creatinine increased, bilirubin increased (mainly direct), increased AST, ALT increased hypokalemia (initially), hyperkalemia (in renal failure), low Na.

Differential diagnosis

Surgical abdominal pain.

Food poisoning.

Diagnosis of complications

Pulmonary edema.

Electrolyte disturbances.

Transformation.

Testing and exploration to do

Blood count

Biochemistry: urea, creatinine, electrolytes, sugar, CK, CKMB, AST, ALT, GGT, alkaline phosphatase, total bilirubin, direct, indirect.

If there is liver damage: do more bilan viral hepatitis.

Arterial blood gas.

Urinary electrolytes.

Electrocardiogram, abdominal ultrasound.

Cardiopulmonary X-ray.

Treatment

Induce vomiting: if taken within the first few hours, before going to the hospital.

Gastric lavage: if the patient has just taken fish bile within the first few hours, the patient vomits less, just wash 2-3 liters.

Activated charcoal: the patient arrives within the first 6 hours, after induction of vomiting or gastric lavage.

Active diuresis:

+ Patients come to the hospital in the first 24 hours, do it as soon as possible, as quickly as possible, especially in the first few hours.

+ Place central venous catheter, administer 0.9% sodium chloride, 5% glucose, ringer lactate, ensure central venous pressure 5-10 cm water, monitor urine and give intravenous diuretic (furosemide). ) to ensure about 200ml/hour.

+ Furosemide (intravenous): 20-40mg initially, after 1 hour of urine failure, increase to 40-80mg, if after 1 hour, 100-200mg/time is not achieved The maximum dose for adults is 200 mg/24 hours.

+ Stop active diuresis if central venous pressure > 12cm water, unresponsive to diuresis, active diuresis 48-72 hours.

Artificial kidney: if the renal failure does not respond to diuretics, urea, creatinine increases, volume overload, electrolyte disturbances, metabolic acidosis.

Electrolyte disorders: corrected by blood electrolytes, by drugs or artificial kidneys.

Decreased gastric secretion: ranitidine, omeprazole, pantoprazole, esomeprazole, intravenous injection.

Stomach lining: Gastropulgite, Phosphalugel...

Hepatitis: do not use drugs harmful to the liver, can use biphenyl-dimethyl-dicarboxylate (Fortec), 25mg, take 4 tablets/day.

Treat other symptoms according to the patient's condition.

Prevention

Propagating and educating people not to drink fish bile.