title: Acute cholestatic liver injury caused by polyhexamethyleneguanidine hydrochloride admixed to ethyl alcohol.
abstract: BACKGROUND
  Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12500 patients were admitted to hospital with a history of drinking illegal cheap "vodka" in 44 different regions in Russia, of whom 9.4% died. In reality, the "vodka" was an antiseptic liquid composed of ethanol (≈93%), diethyl phthalate, and 0.1-0.14% PHMG (brand name "Extrasept-1").
  
  
  METHODS
  We performed an analysis of the clinical features and outcome in four poisoning treatment centers in the cities of Perm, Ekaterinburg, Irkutsk, and Khabarovsk. A total of 579 patients (215 females and 364 males) with similar symptoms were included.
  
  
  RESULTS
  The main symptoms on admission included jaundice (99.7%), skin itch (78.4%), weakness (96%), anorexia (65.8%), dizziness (65.3%), nausea (54.8%), vomiting (22.6%), stomach ache (52.7%), diarrhea (32%), and fever (50%). Mild symptoms were found in 2.5% of cases, moderate in 63%, and severe in 34.5%. Laboratory results were (mean ± SD): total bilirubin 249 ± 158 μmol/L, direct bilirubin 166 ± 97 μmol/L, cholesterol 14 ± 8 mmol/L, alanine aminotransferase 207 ± 174 IU/L, aspartate aminotransferase 174 ± 230 IU/L, alkaline phosphatase 742 ± 751 IU/L, and gamma-glutamyltranspeptidase 1199 ± 1095 IU/L. Patients generally recovered over a period of 1-5 months, although high levels of alkaline phosphatase and gamma-glutamyltranspeptidase were still found in all patients examined after 6 months. Sixty-one patients (10.5%) died between 23 and 150 days after poisoning. Local cholestasis, inflammatory infiltration, and fibrosis developing into cirrhosis were found by liver biopsy.
  
  
  CONCLUSIONS
  Acute liver injury caused by PHMG-hydrochloride or PHMG in combination with either ethanol or diethyl phthalate can be characterized as cholestatic hepatitis with a severe inflammatory component causing high mortality.
authors.affiliation: Research and Applied Toxicology Center of the Federal Medical-Biological Agency, Moscow, Russia. rtiac2003@yahoo.com
authors.forename: Y N
authors.initials: YN
authors.lastname: Ostapenko
authors.forename: K M
authors.initials: KM
authors.lastname: Brusin
authors.forename: Y V
authors.initials: YV
authors.lastname: Zobnin
authors.forename: A Y
authors.initials: AY
authors.lastname: Shchupak
authors.forename: M K
authors.initials: MK
authors.lastname: Vishnevetskiy
authors.forename: V G
authors.initials: VG
authors.lastname: Sentsov
authors.forename: O V
authors.initials: OV
authors.lastname: Novikova
authors.forename: S A
authors.initials: SA
authors.lastname: Alekseenko
authors.forename: O A
authors.initials: OA
authors.lastname: Lebed'ko
authors.forename: Y B
authors.initials: YB
authors.lastname: Puchkov
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000434:Alcoholic Beverages / Q000506:poisoning; D002492:Central Nervous System Depressants / Q000506:poisoning*; D056486:Chemical and Drug Induced Liver Injury / Q000000981:diagnostic imaging / Q000473:pathology*; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000473:pathology*; D019411:Clinical Laboratory Techniques; D004202:Disinfectants / Q000506:poisoning*; D058872:Epidemics; D000431:Ethanol / Q000506:poisoning*; D005260:Female; D006146:Guanidines / Q000506:poisoning*; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000523:psychology; D006801:Humans; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012426:Russia / Q000453:epidemiology; D012737:Sex Factors; D012923:Social Class; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D002492:Central Nervous System Depressants; D004202:Disinfectants; D006146:Guanidines; C060540:polyhexamethyleneguanidine; D000431:Ethanol