Variable hepatic and renal manifestations following grass carp gallbladder ingestion: a three-patient case series...

Fish gallbladder ingestion remains a traditional folk remedy in several Asian countries but may result in severe hepatorenal toxicity. We report three patients admitted to the Poison Control Center, Bach Mai Hospital, Hanoi, Vietnam, following ingestion of grass carp (Ctenopharyngodon idella) gallbladders. A 44-year-old man developed severe hepatocellular injury (peak AST 4442 U/L, ALT 5115 U/L), moderate acute kidney injury (AKI), and prolonged severe hypertension requiring intravenous nicardipine infusion for 88 hr. A 48-year-old man presented with severe AKI (peak creatinine 749 µmol/L) and toxic hepatitis and underwent intermittent hemodialysis because of rapidly progressive renal dysfunction despite preserved urine output. A 73-year-old woman developed severe acute hepatocellular injury with AST and ALT levels exceeding 7000 U/L and ferritin of 40,000 ng/mL but without clinically significant AKI. Peak total bilirubin concentrations were 83.6, 102, and 99 µmol/L in Cases 1, 2, and 3, respectively. Viral hepatitis investigations were negative in all patients. Despite variable clinical phenotypes, all patients recovered with supportive treatment. These cases further illustrate the variable patterns of hepatorenal involvement following grass carp gallbladder ingestion, ranging from dialysis-requiring acute kidney injury to predominant hepatocellular injury with preserved renal function. Because toxin exposure could not be quantified, the observed variability may reflect differences in ingested toxin dose, host susceptibility, or both. These findings highlight interindividual variability in patterns of hepatorenal involvement following grass carp gallbladder ingestion.