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

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 49; no. 6; pp. 471 - 477
• Main Authors: Ostapenko, Y. N., Brusin, K. M., Zobnin, Y. V., Shchupak, A. Y., Vishnevetskiy, M. K., Sentsov, V. G., Novikova, O. V., Alekseenko, S. A., Lebed'Ko, O. A., Puchkov, Y. B.
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01-07-2011; Taylor & Francis
• Subjects: Acute Disease; Adolescent; Adult; Age Factors; Aged; Alcoholic Beverages - poisoning; Central Nervous System Depressants - poisoning; Chemical and Drug Induced Liver Injury - diagnostic imaging; Chemical and Drug Induced Liver Injury - pathology; Cholestasis - diagnostic imaging; Cholestasis - pathology; Cholestatic hepatitis; Clinical Laboratory Techniques; Disinfectants - poisoning; Epidemics; Ethanol - poisoning; Female; Guanidines - poisoning; Hepatic Encephalopathy - chemically induced; Hepatic Encephalopathy - psychology; Humans; Liver - pathology; Liver Function Tests; Male; Middle Aged; Poisoning; Poisoning - diagnosis; Poisoning - epidemiology; Poisoning - mortality; Polyhexamethyleneguanidine hydrochloride; Retrospective Studies; Russia - epidemiology; Sex Factors; Social Class; Ultrasonography; Young Adult
• ISSN: 1556-3650; 1556-9519
• DOI: 10.3109/15563650.2011.592837

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.