Fish bile is poisonous, where is the poison?

A while ago, @People's Daily posted this on Weibo:

There are indeed relevant studies showing that there are 12 bile-toxic fish in my country The bile of grass carp, herring, silver carp, bighead carp, carp, crucian carp, bream, dace, cock-billed bream, red-eyed trout, and round-mouthed copper fish all have certain toxicity. Regardless of whether it is eaten raw, cooked, soaked in wine and swallowed, or used externally such as fish bile eye drops, it will cause poisoning, and the degree of poisoning is positively related to the dose①. However, some people pointed out that fish bile is highly toxic because of carp alcohol, not hydrocyanic acid, histamine and other substances mentioned in Weibo. Is that really the case?

Symptoms of fish gall poisoning

For a long time, influenced by traditional medical classics, there has been a market for saying that fish gall can clear away heat, detoxify, and improve eyesight. In China, especially in the southern coastal rural areas, it is not uncommon for patients to be hospitalized due to poisoning due to swallowing fish gall. Since the first case of fish gall poisoning was reported in China in 1965, there have been 786 cases as of 2001.

Through the analysis of these cases, researchers found that after fish gall poisoning, gastrointestinal symptoms first appeared, mainly abdominal pain, nausea, vomiting, diarrhea, and upper gastrointestinal bleeding, and then many other symptoms were involved. organ. For example, liver disease may cause jaundice and alanine aminotransferase is increased; kidney disease may cause oliguria, anuria, and acute renal failure; other symptoms include blood pressure fluctuations, skin and mucosal bleeding, etc.②.

The clinical manifestations of fish gall poisoning can be roughly divided into three types. Patients with mild poisoning have mainly gastrointestinal symptoms with mild physical signs and can generally recover with symptomatic treatment; patients with moderate poisoning often have liver and kidney damage in addition to gastrointestinal symptoms, but do not suffer from functional failure and do not need dialysis. Treatment; In patients with severe poisoning, renal failure is the typical manifestation. Acute renal failure is not only the earliest and most severe manifestation of fish bile poisoning, but is also often the main cause of patient hospitalization and death. Early preventive dialysis, especially hemodialysis and irrigation, is often the key to successful rescue③.

Research on fish bile poison

In 1991, Japanese scholars took the lead in analyzing fish bile and believed that its toxic component was carp alcohol. In 1992, the Department of Pharmacy of Tongji University selected grass carp gall, used organic solvent chromatography, and then separated and purified it. Animal experiments confirmed that the main toxic component of grass carp gall is sodium carpyl alcohol thioester, and its hydrolyzate is carp alcohol. Sodium carpinothioate is thermally stable and will not be destroyed by ethanol, which can explain the diversity of fish gall poisoning ④.

However, some scholars believe that the hydrocyanic acid in fish bile can inhibit the reactions of more than 40 enzymes, and histamine substances can increase capillary permeability and cause organ bleeding and edema. The key to bile poisoning ⑤.

Comparison of Poisoning Manifestations

Hydrocyanic acid is a cyanide. Its main toxicological effect is to dissociate cyanide ions and interact with oxidative cytochrome oxidase in the mitochondria of human cells. The combination of ferric iron prevents the reduction of ferric iron in oxidase and hinders normal cell respiration. Tissue cells cannot use oxygen, causing tissue hypoxia and causing the body to fall into a state of internal asphyxia. Clinical manifestations include dyspnea, lowered blood pressure, and the patient's breath smells like bitter almonds. The main rescue measures include oxygen inhalation, isoamyl nitrite inhalation, and intravenous injection of sodium nitrite. Histamine poisoning is typically characterized by skin flushing, ciliary membrane congestion, throat burning, urticaria, etc., and usually recovers well. From this point of view, whether it is clinical manifestations or rescue methods, hydrocyanic acid and histamine poisoning are inconsistent with patients with fish gall poisoning. Based on this, the author believes that the toxic component of fish gallbladder should be sodium carpyl alcohol thioester.

Of course, one final point must be emphasized: do not believe in folk remedies. In the mid-1970s, pharmacological research on fish bile found that the bile of some carp fish did have antitussive, phlegm-reducing, and short-term antihypertensive effects. The toxic dose is very close to the effective dose, and if you are not careful, it may endanger your health⑥. If you want to relieve cough, reduce phlegm, and lower blood pressure, it is far better to follow the doctor's advice and choose other drugs. It is absolutely impossible to expect that the folk remedies of fish gall can play a magical role that current medicine cannot.

References

[1] Wu Hanlin, Chen Yonghao. Research on bilious fishes in China [J]. Journal of Shanghai Fisheries University, 2001, 10(2): 102-108.

[2] Hu Xiangren, Lu Lin, Wang Yunsheng, et al. Clinical analysis and treatment methods of acute fish bile poisoning (with 86 cases report) [J]. Southwest National Defense Medicine, 2001, 11(3 ): 190-192.

[3] Meng Xinke, Deng Yuelin. Research progress on fish gall poisoning[J]. Chinese Critical Care Medicine, 2000, 12(7): 437-438.

[4] Shi Chaozhou, Mao Yufeng, Fan Qixin. Research on toxic components of fish bile [J]. Journal of Tongji Medical University, 1992, 21(3): 168-171.

[5] Deng Yuelin, Xiao Guilin, Jin Yiqiang, et al. Clinical observation of multiple organ dysfunction syndrome caused by fish bile poisoning [J]. Chinese Journal of Integrated Traditional Chinese and Western Medicine, 2001, 21(8): 582-584.

[6] Wu Hanlin, Chen Yonghao. Animal experimental study on acute bile poisoning in carps [J]. Zoological Research, 1999, 20(6): 475-476.

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Author: Zhao Yanchang