Myth can be fatal and must not be followed blind-folded

Manipal Hospitals, Salt Lake, Kolkata, the second-largest healthcare provider in India has once again created another milestone and imparted awareness by saving a life that could have been lost due to a myth. The expert team led by Dr. Sujoy Maitra Consultant Gastroenterologist, Dr. Jayanta Dutta Consultant Nephrologist and Dr. Dipankar Sarkar Consultant Internal Medicine & Critical Care took prominent steps to treat the patient with a considerate approach who has consumed fish bile.

Sneha Roy, (name changed) a middle-aged homemaker and diabetic is another example of many such people undertaking treatment backed by some myth. She consumed fish bile to get cured of her diabetes.  It is quite a known practice in southern India and parts of eastern India to consume raw fish where a myth persists that eating fish-bile can cure diabetes and Roy is one those people who has taken upon these myths as an alternate medication. Mrs. Roy was brought to Manipal Hospitals with complaints of acute abdominal pain. Post admission, it was observed that she suffered from multi-organ failure, low blood pressure, hypotension and was also in a state of shock. She was immediately admitted to the intensive care unit with a provisional diagnosis of acute pancreatitis and started on supportive treatment. Her initial reports showed a significant derangement of liver and kidney functions – so the common causes of liver kidney injuries like leptospirospirosis, hepatorenal syndrome or drug induced organ damage were being considered. But when further tests did not match with these diagnoses, the treating team started rethinking about the possible cause of her illness. Upon questioning the patient, it was known that she had been consuming fish bile of Rohu or any other big fish to control her diabetes for four consecutive days preceding her illness.

Dr Sujoy Maitra said ‘’ There were two special challenges in this case. First- although there have been many cases of fish bile poisoning from different parts of India and South Asian countries, this is the first of its kind reported officially from Kolkata, the heartland of fish loving people the Bengalis. As a result, we struggled with multiple differential diagnoses of liver-kidney injury till we stumbled on the discovery of her consuming fish bile a few days before the illness. Second – although from clinicians’ perspective acute renal and liver injury are the two most alarming events in fish bile poisoning cases, nevertheless from patients’ perspective the commonest debilitating symptoms of fish bile poisoning are gastrointestinal – severe nausea, and persistent abdominal pain leading   to poor oral intake which became the biggest challenge in this patient as she was on daily haemodialysis with a high protein energy nutritional demand’’

Dr. Dipankar Sarkar Consultant Internal Medicine & Critical Care said, “Eating fish bile leads to acute kidney and liver injury that may lead to long term dialysis. Myth of taking fish bile to cure diabetic state was falsely evolved as the partially damaged kidney requires less dose of antidiabetic medication but in this situation, sugar remains low at the expense of kidney dysfunction. The team of expert doctors upon examination found that Mrs. Roy’s condition was deteriorating and within 72 hours, Roy had to undergo dialysis. Initially dialysis was challenging due to her low blood pressure and we had to put her on sled dialysis. Once her blood pressure revived to normal, we started conventional dialysis. During her month-long hospitalization, dialysis was provided to her in phase wise. First few days she was on regular dialysis and then alternate days and finally once a week. The urea and creatinine level slowly normalized and urine volume also raised to 1.5-2 Lt per day.”

Dr. Jayanta Dutta Consultant Nephrologist said, “The patient was admitted to ICU with acute renal failure and she needed dialysis. The reason behind renal failure was consumption of fish bile which is highly toxic to the liver and kidneys. It is also very difficult to diagnose the problem faced by the patient as there is no such procedure and getting patient history is the only option to know the cause. I have witnessed 10-12 cases in my career where a myth has led to these cases that fish bile can cure diabetes. It could have been fatal so it’s important to create awareness.”

Mr. Arindam Banerjee, Director Manipal Hospitals said, “Myths have led to various incidents and it is one of the cases where the expertise and promptness of our doctors saved a fatality. It is always advisable to consult a medical practitioner before intaking any medication for any disease. Taking any form of medication or substances such as fish bile without medical guidance can cause severe damage to various body organs and it is strictly advised to not to fall into any myths and to follow doctors advice and medications only.”

Roy was released after 3-4 weeks from the hospital and was called for dialysis once a week on OPD basis. Now her condition is quite improving and she has been not under dialysis for ten days now and is under medication and is visiting hospital for follow-up.