Abstract
This study evaluates the clinical efficacy of activated charcoal combined with mannitol (ACM) for the treatment of Haff disease. This is a retrospective cohort study conducted at the Emergency Department of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine. Consecutive patients who were hospitalized during a two-year time frame (from June 2016 to August 2017) and diagnosed with Haff disease were reviewed. Clinical symptoms, laboratory findings, pain/anxiety scores, and treatment-related adverse events were collected. Sixty-eight Haff disease patients after boiled crayfish consumption were enrolled in this study. Besides standard treatments for Haff disease, 22 patients had an oral administration of activated charcoal and mannitol within 12 hours of hospital admission (ACM group), while the other 46 patients did not receive such treatment (non-ACM group). Baseline characteristics including clinical symptoms, serum enzyme levels, and pain/anxiety scores were comparable between the two groups. Activated charcoal and mannitol treatment led to lower CK-MB and AST levels from 12 hours to 60 hours, lower ALT and LDH levels from 12 hours to 72 hours, and lower CK levels from 24 hours to 72 hours after hospitalization. Patients in the ACM group had significantly shortened duration of hospital stays (7.5 [6.0–8.0] days vs 8.0 [6.8–10.0] days, p = 0.032) and lower anxiety scores 24 hours after hospital admission (40.7 ± 4.9 vs 44.1 ± 6.3, p = 0.032) than in the non-ACM group. No patient experienced treatment-related adverse events. The overall prognosis of both groups is good. Among patients with Haff disease caused by boiled crayfish, activated charcoal combined with mannitol treatment resulted in shorter hospital stays, lower serum CK, CK-MB, AST, ALT, and LDH levels, and lower anxiety scores.
Highlights
Haff disease is a rare syndrome of unexplained myalgia and rhabdomyolysis in a person who ate certain types of cooked freshwater fish or crustacean in the 24 hours before onset of illness [1]
As eating boiled crayfish grew prevalent in Southeast China, Haff disease patients suddenly shot up in 2016, when 494 cases were reported from 15 different hospitals in Nanjing during 5 July to 29 August, 2016 [7]. is outbreak was associated with consumption of crayfish produced from the Yangtze River and its surrounding water system
From the Electronic Medical Record System at our hospital, we retrospectively reviewed 71 consecutive adult patients who ate boiled freshwater crayfish within 24 hours before onset of Haff disease admitted to our emergency department from June 2016 to August 2017. e diagnostic criteria for Haff disease were as follows: (1) patients presented with rhabdomyolysislike symptoms, such asacute-onset myalgia, transient muscle weakness, or hematuria and (2) laboratory results revealed a fivefold or greater elevation in creatine kinase (CK) levels with an MB fraction < 5% [8]. e exclusion criteria included patients who had other diseases with elevated CK levels, such as acute coronary syndrome and who had a recent history of trauma or intense exercise and incomplete clinical data
Summary
Haff disease is a rare syndrome of unexplained myalgia and rhabdomyolysis in a person who ate certain types of cooked freshwater fish or crustacean in the 24 hours before onset of illness [1]. Since 2016, the number of patients diagnosed with Haff disease presenting in our emergency is surging Studies that reported this outbreak focused on epidemiological investigation, and few studies tried to explore the treatment for these patients. From the Electronic Medical Record System at our hospital, we retrospectively reviewed 71 consecutive adult patients who ate boiled freshwater crayfish within 24 hours before onset of Haff disease admitted to our emergency department from June 2016 to August 2017. E diagnostic criteria for Haff disease were as follows: (1) patients presented with rhabdomyolysislike symptoms, such as (sub)acute-onset myalgia, transient muscle weakness, or hematuria and (2) laboratory results revealed a fivefold or greater elevation in CK levels with an MB fraction < 5% [8]. Ese patients received activated charcoal and mannitol treatments once 12 hours within hospital admission. A two-tailed p value of less than 0.05 was considered statistically significant
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