Acute Renal Failure due to Fish Bile Poisoning in Construction Worker
35 y/o Male Construction Worker came to the OPD with complaints of loose motions, nausea, vomitting since two days.
On physical examination, signs of dehydration were found.
Laboratory examination revealed T C-7400/cu.mmm; P68, L27, M2, E3, ESR- 10; Hb-11.0 gm, S. creatinine 3.4 mg/dl; urea- 110 mg/dl; S. protein level- 7.5 mg/dl; Serum Na+-137 meq/l; Serum K+ 4.1 meq/l; S. calcium 8.1 mg/ dl; S. amylase 38 mg/dl; S. lipase 46 mg/dl; urine routine examination revealed presence of albumin. Blood sugar level, LFT, serum lipid profile, ECG, plain radiograph of KUB, chest X-ray, renal ultrasound all were normal. Kidney biopsy was not done.
The eitology of fish Bile consumption was obtained only after repeated diet enquiry. patient said to have consumed road side fish bile which was as cheap as 2 rupees, he assumed to have been able to increase stamina.
Patient was managed conservatively for ARF and other clinical problems. Repeat renal function tests revealed further elevation of serum creatinine.
Patient was put on hemodialysis on the third day of hospitalization and required 3 sittings of hemodialysis and on the eighth day after third haemodialysis blood urea came down to 60 mg/dl, S. creatinine 3.0 mg/dl, S Na+ 137 meq/l, S k+ 4.0 meq/l.
He showed signs of improvement, diuretics were started, and was discharged on the twelfth day with the normal urine out put with normal electrolyte levels.
Recently, studies have shown that fish gall bladder can also damage the heart, liver, gastro-intestinal tract and lead to multiple organ dysfunction syndrome (MODS) in addition to ARF.
Ciguatera and scombroid poisoning are the most commonly recognized while poisoning with grass carp (Ctenopharyngodon idellus) is less known.
History Taking plays a major role in diagnosis of such cases.