Dwijen Das

Dwijen Das

Silchar Medical College and Hospital, India

Title: A case series on fish bile toxicity


Dwijen Das has completed his MBBS at the age of 23 years from Gauhati University and MD in general Medicine from Dibrugarh University, Assam, India in 2004. He is working as Associate Professor and In Charge dialysis unit in Silchar Medical College, a premier Medical Institute in north eastern India. He has published more than 15 papers in reputed journals and has been serving as an editorial board member of Assam Journal of Internal Medicine. He is also a peer reviewer in 2 national reputed journals


Labeo rohita, commonly known as “Rohu” an Indian variety of the fish belonging to the carp species is a fresh water fish and is commonly consumed in north eastern India. The raw fish gall bladder is consumed by some people with different beliefs ranging from visual improvement, cure for gastric related diseases, rheumatism or aphrodisiac especially among the younger population. The toxicity induced by the fish bile leads to a variety of manifestations ranging from gastro intestinal upset, hepatic and renal dysfunctions which can be fatal and may lead to mortality unless timely intervention is done. We, report a series of three consecutive cases of fish bile toxicity all of whom had similar presentations of acute onset abdominal pain, cramps, nausea, vomiting with tachycardia, tachypnoea, abdominal distension followed by hepatic dysfunctions like jaundice, raised alanine aminotransferase and aspartate aminotransferase and nephrotoxic manifestations in the form of acute kidney injury leading to oliguria or anuria and raised creatinine levels. All the cases recovered with intravenous fluid replenishment, symptomatic management and supportive hemo- dialysis. Apart from the established nephrotoxins like paraphenylenediamine hair dye, snake venom, paraquat, paracetamol, herbal medicines, cotinarius mushrooms leading to acute kidney injury, lesser known substances like various bile components namely cyprinol, a C-27 alcohol found in the bile of cyprinid fish and 5α cyprinol sulfate has a deleterious effect on the kidneys. 5α cyprinol sulfate found in 5 species of fish belonging to the order cypriniformes have been associated with bile induced hepatitis and renal failure