Acute cholestatic liver injury caused by polyhexamethyleneguanidine hydrochloride admixed to ethyl alcohol

Autor:	M. K. Vishnevetskiy, Yuri N. Ostapenko, Y. V. Zobnin, K. M. Brusin, A. Y. Shchupak, V. G. Sentsov, O. V. Novikova, O. A. Lebed'ko, Y. B. Puchkov, S A Alekseenko
Rok vydání:	2011
Předmět:	Adult Male Cirrhosis Adolescent Bilirubin Nausea Toxicology Guanidines Russia Young Adult chemistry.chemical_compound Sex Factors Liver Function Tests Cholestasis medicine Humans Epidemics Aged Retrospective Studies Ultrasonography Ethanol medicine.diagnostic_test Clinical Laboratory Techniques business.industry Alcoholic Beverages Poisoning Age Factors Central Nervous System Depressants General Medicine Middle Aged Jaundice medicine.disease Liver Social Class chemistry Hepatic Encephalopathy Liver biopsy Anesthesia Acute Disease Vomiting Female Chemical and Drug Induced Liver Injury medicine.symptom Liver function tests business Disinfectants
Zdroj:	Clinical Toxicology. 49:471-477
ISSN:	1556-9519 1556-3650
DOI:	10.3109/15563650.2011.592837
Popis:	Introduction . Polyhexamethyleneguanidine hydrochloride (PHMG) is an antimicrobial biocide of the guanidine family. In the period from August 2006 to May 2007, more than 12 500 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 ” ). Material and 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 μ mol/L, direct bilirubin 166 97 μ mol/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 gammaglutamyltranspeptidase 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, infl ammatory infi ltration, and fi brosis developing into cirrhosis were found by liver biopsy. Conclusion. 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 infl ammatory component causing high mortality.
Databáze:	OpenAIRE
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