title: Acute renal failure and hepatitis following ingestion of carp gallbladder.
abstract: BACKGROUND
  Fish gallbladder has long been used as folk remedy in China. Poisoning due to carp gallbladder ingestion has been reported in many countries but the majority of cases are in Chinese journals. We report a case of grass carp gallbladder poisoning and review the literature, including the Chinese reports.
  
  
  METHODS
  A 67 year old woman ingested a grass carp gallbladder and complained of nausea and epigastric pain in two hours, and had elevated alanine aminotransferase by 8 hours. She developed oliguria on day three and hemodialysis was performed on day five, following which she gradually recovered and was discharged on day 26.
  
  
  CONCLUSIONS
  Carp gallbladder contains 5 alpha-cyprinol sulphate, which is hepatotoxic and nephrotoxic. The exact mechanism of toxicity is unknown. Mild poisoning causes only gastroenteritis, liver and kidneys are affected in moderate poisoning, and multi-organ failure occurs in severe poisoning. The initial symptoms are nausea, vomiting, diarrhea and abdominal pain, which usually occur 5 to 12 hours after ingestion. Raised liver enzymes or jaundice occurs in 75% to 87% of patients. Acute renal impairment occurs in 72% to 87% of patients, usually on day 3 to 6. Treatment is supportive and often included hemodialysis.
  
  
  CONCLUSIONS
  The ingestion of grass carp gallbladder may result in transient hepatitis with subsequent acute renal failure. This case also illustrated the importance of understanding the use and potential serious complications of alternative medicines. Fish gallbladder poisoning should be considered in unexplained acute renal failure in Chinese and Asian patients.
authors.affiliation: Hong Kong Poison Information Centre, Room 2A, Block K, United Christian Hospital, 130 Hip Wo Street, Kwan Tong, Hong Kong, Administrative Region. kungsw@netvigator.com
authors.forename: Shu Wing
authors.initials: SW
authors.lastname: Kung
authors.forename: Yiu Cheung
authors.initials: YC
authors.lastname: Chan
authors.forename: Man Li
authors.initials: ML
authors.lastname: Tse
authors.forename: Fei Lung
authors.initials: FL
authors.lastname: Lau
authors.forename: Tai Lin
authors.initials: TL
authors.lastname: Chau
authors.forename: Man Kei Paul
authors.initials: MK
authors.lastname: Tam
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D000368:Aged; D000818:Animals; D002347:Carps; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000628:therapy; D002777:Cholestanols / Q000506:poisoning*; D005260:Female; D005704:Gallbladder; D006801:Humans; D008516:Medicine, Chinese Traditional / Q000009:adverse effects*; D006435:Renal Dialysis; D014118:Toxins, Biological / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D002777:Cholestanols; D014118:Toxins, Biological; C023378:anhydrocyprinol