Research and Applied Toxicology Center of the Federal Medical-Biological Agency, Moscow, Russia.
Clin Toxicol (Phila). 2011 Jul;49(6):471-7. doi: 10.3109/15563650.2011.592837. Epub 2011 Jul 15.
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").
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.
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.
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.
聚六亚甲基胍盐酸盐（PHMG）是胍类家族的一种抗菌杀生物剂。2006 年 8 月至 2007 年 5 月，俄罗斯 44 个不同地区有 12500 多名患者因饮用非法廉价“伏特加”而住院，其中 9.4%死亡。实际上，“伏特加”是一种由乙醇（≈93%）、邻苯二甲酸二乙酯和 0.1-0.14% PHMG（商品名“Extrasept-1”）组成的防腐剂液体。
我们对 Perm、Ekaterinburg、Irkutsk 和 Khabarovsk 四个中毒治疗中心的临床特征和结果进行了分析。共有 579 名（215 名女性和 364 名男性）具有相似症状的患者纳入研究。
入院时的主要症状包括黄疸（99.7%）、皮肤瘙痒（78.4%）、乏力（96%）、食欲不振（65.8%）、头晕（65.3%）、恶心（54.8%）、呕吐（22.6%）、腹痛（52.7%）、腹泻（32%）和发热（50%）。轻度症状占 2.5%，中度症状占 63%，重度症状占 34.5%。实验室结果为（平均值±标准差）：总胆红素 249±158μmol/L，直接胆红素 166±97μmol/L，胆固醇 14±8mmol/L，丙氨酸氨基转移酶 207±174IU/L，天冬氨酸氨基转移酶 174±230IU/L，碱性磷酸酶 742±751IU/L，γ-谷氨酰转肽酶 1199±1095IU/L。患者通常在 1-5 个月内康复，尽管所有接受检查的患者在 6 个月后仍发现碱性磷酸酶和γ-谷氨酰转肽酶水平较高。61 名（10.5%）患者在中毒后 23-150 天死亡。肝活检显示胆汁淤积性肝炎伴有严重炎症成分，可导致高死亡率。
由 PHMG-盐酸盐或 PHMG 与乙醇或邻苯二甲酸二乙酯联合引起的急性肝损伤可表现为伴有严重炎症成分的胆汁淤积性肝炎，导致高死亡率。
