Gut decontamination, including whole-bowel irrigation, may be necessary for amatoxins.
Beyond the first postprandial hour, orogastric lavage is not recommended, because of its questionable efficacy.
Activated charcoal plays a much more important role in limiting absorption of most toxins and is indicated for all patients with amatoxin mushroom poisoning, regardless of the timing of presentation.
Muscarine poisoning
Most patients with poisoning due to mushrooms containing muscarine can be treated without medications.
If patients exhibit excessive bronchial secretions or other symptoms of cholinergic excess (bradycardia) that are of significant concern, atropine (small doses) infusion may decrease these symptoms.
Liver transplantation Indications for immediate OLT include the following:
Stage III hepatic encephalopathy
Serum bilirubin levels higher than 4.6 mg/dL
Prothrombin time (PT) prolongation unresponsive to FFP infusions (patients with a PT >100 s should be considered for transplantation)
Age younger than 12 years
Serum creatinine level higher than 1.4 mg/dL
Hemorrhage
Shock
Acidosis
Hypoglycemia
Oral form silymarin may be obtained.
Other recommended therapies for amatoxin poisoning include the following:
IV benzyl penicillin – Reduces the uptake of amatoxin by hepatocytes
Cimetidine - Inhibits CYP450 enzymes, presumably reducing metabolism of alpha-amanitin into hepatotoxic metabolites
N -acetylcysteine (NAC) - A thiol containing glutathione precursor with free radical binding capacity and antioxidant effects
Systemic toxicity and seizures results from reduced concentrations of GABA
overcome by the infusions of pyridoxine (vitamin B-6) if they do not respond to benzodiazepines.
Inhibit the transformation of folic acid to tetrahydrofolic acid.
Therefore, patients with severe gyromitrin toxicity should receive folinic acid, as an adjunctive therapy
management of complications of poisoning
Rhabdomyolysis is treated with aggressive IV fluid resuscitation
Methemoglobinemia is treated with IV methylene blue
Hemolysis is usually mild, necessitates the administration of large amounts of IV fluids only to prevent renal complications; blood transfusions are rarely required.
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treatment of Mushroom toxicity
1. Treatment
Gut decontamination, including whole-bowel irrigation, may be necessary for
amatoxins.
Beyond the first postprandial hour, orogastric lavage is not recommended,
because of its questionable efficacy.
Activated charcoal plays a much more important role in limiting absorption of
most toxins and is indicated for all patients with amatoxin mushroom
poisoning, regardless of the timing of presentation.
Muscarine poisoning
Most patients with poisoning due to mushrooms containing muscarine can
be treated without medications.
If patients exhibit excessive bronchial secretions or other symptoms of
cholinergic excess (bradycardia) that are of significant concern, atropine
(small doses) infusion may decrease these symptoms.
2. Treatment
Liver transplantation Indications for immediate OLT include the following:
Stage III hepatic encephalopathy
Serum bilirubin levels higher than 4.6 mg/dL
Prothrombin time (PT) prolongation unresponsive to FFP infusions (patients with a PT >100 s should
be considered for transplantation)
Age younger than 12 years
Serum creatinine level higher than 1.4 mg/dL
Hemorrhage
Shock
Acidosis
Hypoglycemia
3. Toxin-specific treatment –
Amatoxin poisoning
Oral form silymarin may be obtained.
Other recommended therapies for amatoxin poisoning
include the following:
IV benzyl penicillin – Reduces the uptake of
amatoxin by hepatocytes
Cimetidine - Inhibits CYP450 enzymes, presumably
reducing metabolism of alpha-amanitin into
hepatotoxic metabolites
N -acetylcysteine (NAC) - A thiol containing
glutathione precursor with free radical binding
capacity and antioxidant effects
4. Gyromitrin poisoning treatment
Systemic toxicity and seizures results from reduced concentrations of GABA
overcome by the infusions of pyridoxine (vitamin B-6) if they do not respond
to benzodiazepines.
Inhibit the transformation of folic acid to tetrahydrofolic acid.
Therefore, patients with severe gyromitrin toxicity should receive folinic acid, as
an adjunctive therapy
management of complications of poisoning
Rhabdomyolysis is treated with aggressive IV fluid resuscitation
Methemoglobinemia is treated with IV methylene blue
Hemolysis is usually mild, necessitates the administration of large amounts of
IV fluids only to prevent renal complications; blood transfusions are rarely
required .
