Fish gallbladder poisoning

　　It is mainly due to the use of fish gallbladders for 'clearing heat', 'improving eyesight', and 'relieving cough and asthma', which generally occur after eating raw fish gallbladders, with milder symptoms in a few cases of cooked consumption. The fish species that cause poisoning include white croaker, grass carp, crucian carp, crucian carp, mizuna, pomfret, and headwater fish, etc., with the weight of the fish generally more than 2 to 3 catties, and the number of fish gallbladders eaten ranging from 1/2 to 10 or more. Although there are individual differences in the severity of poisoning, it is mainly related to the amount ingested. According to the pharmacology of Nanjing College of Traditional Chinese Medicine, the dosage of crucian carp gallbladder is 1 to 2.5g, but generally even half of a large fish gallbladder far exceeds this amount. Two fish gallbladders for children and 8 to 13 for adults can cause death.

　　Severe poisoning can cause liver enlargement, jaundice, pain in the liver area, facial edema, as well as oliguria, proteinuria, hematuria, anuria, lumbar pain, and other urinary system symptoms. Severe liver and kidney dysfunction can lead to acute fulminant toxic hepatitis, even causing hepatic encephalopathy. At the same time, due to kidney dysfunction, it may develop into acute renal failure, and dialysis treatment may be required when necessary. Therefore, this disease requires dynamic monitoring of liver and kidney function indicators, as well as electrolytes and myocardial enzyme profiles.

　　The onset is acute, most often occurring 1 to 3 hours after ingesting fish gallbladders. In the early stage, it is mainly gastrointestinal symptoms, while in the late stage, it is liver and kidney dysfunction. Initially, vomiting and abdominal pain appear, due to mucosal lesions in the upper gastrointestinal tract caused by toxins, vomiting is severe, and can reach more than 30 times a day, vomiting food and even bile, sometimes with blood. Abdominal pain is usually paroxysmal, located in the upper abdomen, and not too severe. Diarrhea is mild, presenting as indigestible stools. One to two days after onset, the liver gradually swells, liver function is damaged, jaundice occurs, toxins are mainly excreted by the kidneys, so it is easy to cause necrosis of the proximal tubules and obstruction of the collecting ducts, leading to oliguria, even anuria, urinary protein positive, microscopic examination can see red blood cells and granular casts. Severe cases may develop renal failure, with increased non-protein nitrogen in the blood, decreased carbon dioxide binding power, increased blood potassium, decreased blood chloride and potassium. In addition, patients often have fever, lassitude, and children are prone to increased blood pressure. Severe cases may lead to coma, dehydration, shock, repeated convulsions, and even death.

　　Autopsy mainly shows edema, hemorrhage of the mucosa in the stomach and upper jejunum, turbid and swollen liver cells, degeneration of renal tubules, necrosis, hemorrhage of renal papillae and renal pelvis, edema of the heart, lungs, and brain.

　　There is currently no specific antidote for this disease, and emphasis should be placed on prevention. After being infected, comprehensive treatment should be adopted, with the focus on preventing and treating acute renal failure and early dialysis treatment. It is advised that people avoid eating raw fish gallbladders and seek medical treatment as soon as possible after being infected.

　　Some areas in China have the folk custom of ingesting fish gallbladders to treat certain diseases, believing that they have functions such as 'clearing heat and detoxifying', 'improving eyesight', and 'relieving cough and asthma'. Therefore, it is necessary to publicize the knowledge and hazards of fish gallbladders being toxic and not to abuse the ingestion of fish gallbladders for treating diseases.

　　In the diagnosis of fish gallbladder poisoning, in addition to relying on clinical manifestations, auxiliary examinations are also needed. Blood routine, urine routine, liver function, renal function tests, electrocardiogram, and other examinations are helpful to clarify the diagnosis.

　　After fish gallbladder poisoning, attention should be paid to avoiding spicy and irritating foods in diet, and some fine and easy-to-digest foods such as congee, soup, and egg custard should be eaten during the recovery period. Gradually return to normal diet later. It is also necessary to pay attention to light diet and eat less greasy foods at the beginning. Eggs, milk, soy products, vegetables, and fruits can be eaten appropriately, which is helpful for improving the patient's nutrition and restoring their physical condition.

　　There is currently no effective treatment method, mainly general treatment and symptomatic treatment for poisoning, the key to successful rescue lies in the correct handling of renal failure, going through the critical period, waiting for the regeneration of the degenerated and necrotic renal tubular epithelial cells, and then recovery. In the early stage of the disease, gastric lavage should be performed, and for those with severe vomiting, fluid replacement should be corrected for acidosis, but attention should be paid to urine volume and kidney function during fluid replacement. For patients with renal failure, fluid intake and output and the supplementation of electrolytes should be strictly calculated according to the fluid replacement method for renal failure patients. If the fluid intake is too large, it often accelerates death. Peritoneal dialysis or hemodialysis may be necessary to help patients go through the critical period. There have been reports of hemofiltration treatment for severe fish gallbladder poisoning, which is relatively simple in equipment and operation. For patients with renal failure after eating fish gallbladders, early use of hemofiltration therapy has a good effect. For children with abnormal liver function, liver-protecting treatment should be given. In addition, broad-spectrum antibiotics should be administered to prevent infection, especially Gram-negative bacilli infection.

　　1. Symptomatic treatment: induce vomiting, gastric lavage, catharsis, reduce the absorption of toxins.

　　2. Prevent and treat acute renal failure, early dialysis treatment.

　　3. Protect liver and kidney function, take oral or intravenous glucose, Gan Tai Le and a large amount of vitamin C, and other liver-protecting drugs.

　　4. Severe cases use adrenal cortical hormones.