Document Detail

Acute cholestatic liver injury caused by polyhexamethyleneguanidine hydrochloride admixed to ethyl alcohol.
MedLine Citation:
PMID:  21761961     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: 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").
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 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.
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 inflammatory component causing high mortality.
Y N Ostapenko; K M Brusin; Y V Zobnin; A Y Shchupak; M K Vishnevetskiy; V G Sentsov; O V Novikova; S A Alekseenko; O A Lebed'ko; Y B Puchkov
Publication Detail:
Type:  Journal Article     Date:  2011-07-15
Journal Detail:
Title:  Clinical toxicology (Philadelphia, Pa.)     Volume:  49     ISSN:  1556-9519     ISO Abbreviation:  Clin Toxicol (Phila)     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-08-09     Completed Date:  2011-09-30     Revised Date:  2012-03-15    
Medline Journal Info:
Nlm Unique ID:  101241654     Medline TA:  Clin Toxicol (Phila)     Country:  England    
Other Details:
Languages:  eng     Pagination:  471-7     Citation Subset:  AIM; IM    
Research and Applied Toxicology Center of the Federal Medical-Biological Agency, Moscow, Russia.
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MeSH Terms
Acute Disease
Age Factors
Alcoholic Beverages / poisoning
Central Nervous System Depressants / poisoning*
Cholestasis / pathology*,  ultrasonography
Clinical Laboratory Techniques
Disinfectants / poisoning*
Drug-Induced Liver Injury / pathology*,  ultrasonography
Ethanol / poisoning*
Guanidines / poisoning*
Hepatic Encephalopathy / chemically induced,  psychology
Liver / pathology
Liver Function Tests
Middle Aged
Poisoning / diagnosis,  epidemiology,  mortality
Retrospective Studies
Russia / epidemiology
Sex Factors
Social Class
Young Adult
Reg. No./Substance:
0/Central Nervous System Depressants; 0/Disinfectants; 0/Guanidines; 31961-54-3/polyhexamethyleneguanidine; 64-17-5/Ethanol
Comment In:
Clin Toxicol (Phila). 2011 Jul;49(6):441-2   [PMID:  21824054 ]
Clin Toxicol (Phila). 2012 Feb;50(2):154-5; author reply 156   [PMID:  22216917 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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