Concurrent acute kidney injury and acute hepatitis resulting from raw fish gallbladder ingestion: a preventable cause of community acquired organ damage

In south-east Asia, there has been a common belief, mainly in rural areas, that ingesting raw fish gall bladder can help cure certain health problems. Unfortunately, raw fish bile has both nephrotoxic and hepatotoxic effects. In this report, we present a case of 42-year-old man, who presented with acute kidney injury and jaundice. Meticulous history revealed that his ailment resulted from raw Rohu fish gallbladder ingestion. Birdem Med J 2021; 11(1): 70-71

Cardiac Arrests after Eating Raw Grass Carp Gall Bladders: A Case Report

BACKGROUND: Cases of poisoning by eating raw fish gallbladder occur mainly in Asia. These cases have been reported mainly with acute liver and kidney damage. We found that the ingestion of carp gallbladder also caused myocardial damage and lead to frequent cardiac arrest in patients with subclinical long QT interval syndrome. Patient concerns: We report a 57-year-old woman with an unexplained Long QT syndrome history who developed arrhythmia sudden death two times following ingestion of raw fish gall bladder.Fish bile poisoning, toxic hepatitis, acute renal failure, cardiac arrest, postoperative cardiopulmonary resuscitation, long QT syndrome were diagnosed. As in this case, myocardial injury caused by fish bile poisoning further leads to cardiac arrest related to LQTS.The patient underwent continued renal replacement therapy (CRRT) and other supportive treatments to manage symptoms, promote detoxing, protect liver and myocardium in our hospital. Then she completed a cardiac pacemaker placement in local hospital.Her liver enzymes profile returned to normal after 18 days, and kidney injury index returned to normal after more than one month. On follow up after three months, her renal as well as the liver parameters were found normal and she never attack malignant arrhythmia again.Conclusion: Eating fish bile can lead to MODS, not merely to liver and kidney damage. Some of the LQTS patients usually have no clinical symptoms. Clinicians should be aware of changes in low-risk LQTS patients when something special happens to them.

In vitro study of Lactobacillus plantarum properties as a potential probiotic strain and an alternative method to antibiotic treatment of fish

The presence of lactic acid bacteria (LAB) favors the stabilization of intestinal flora, facilitates digestion, improves the assimilability of fodder, and has an immunomodulatory effect on the immune system. According to current research, the application of LAB following antibiotic treatment prevents the development of opportunistic bacteria inhabiting the digestive tract. In the study the potential probiotic properties of Lactobacillus plantarum strains, which can be administered as an alternative to antibiotic treatment in aquaculture, were investigated under in vitro conditions. The strains of L. plantarum were characterized for important properties such as the ability to grow in the presence of 10% fish bile, a tolerance of low pH, and antagonism to pathogens dangerous for fish such as Aeromonas salmonicida and Pseudomonas fluorescens; therefore, they meeting the criteria for strains with probiotic properties. In view of currently increasing resistance to antibiotics and a decrease of their efficiency, probiotic bacteria can serve to support immunity to infections in the future.

A Case of Application of Bedside Continuous Renal Replacement Therapy on Treatment of MODS Caused by Fish Bile Poisoning

One case of 54 years old female patient was admitted to hospital due to vomiting and diarrhea for 3 days and abnormal renal function for 1 day. The patient appeared repeatedly vomiting and watery stools 6 hours after eating 2 grain of raw carp fish bile and gradually appeared oliguresis, whole body skin yellow dye and fever symptoms. The condition of patient had no improvement after visiting the emergency department of local county hospital. She was checked in department of nephropathy in our hospital for further diagnosis and treatment. Because the patient's condition was serious and the function of liver and kidney was damaged, diagnosed as severe multiple organ dysfunction syndrome (MODS), she was transferred to ICU rescue to protect the liver, maintain water and electrolyte balance, control blood sugar, improve the circulation and give other drug treatments and actively carry out bedside continuous renal replacement therapy. Then the body temperature and hemogram of the patients became normal, liver and kidney function improved obviously, urinary production became normal, skin yellow dye faded and vital signs became stable. The successful treatment of this patient indicated that bedside continuous renal replacement therapy can not only have a good support for the kidneys but also reduce the waterfall effect of inflammatory of patients with severe MODS, which has great therapeutic effect on the multi organ dysfunction caused by fish bile poisoning.