Metabolic Acidosis during Treatment of Mushroom Poisoning: A Diagnostic Pitfall

Abstract

Metabolic acidosis is a frequently encountered acid-base disturbance in hospitalized patients that occasionally develops in the course of treatment with medications used in everyday clinical practice, including propylene glycol-containing drugs (lorazepam, diazepam, etomidate, pentobarbital). Disruption of enterohepatic circulation with activated charcoal is a common practice for several intoxications, including mushroom poisoning. Herein, we present a patient who was hospitalized due to mushroom intoxication and developed severe metabolic acidosis as a treatment side effect rather than from the mushroom poisoning. Τo the best of our knowledge, this is the first report on propylene glycol-containing activated charcoal-induced metabolic acidosis.

Preliminary evaluation of a quantitative ethylene glycol test in dogs and cats

“…However, a dose that is 100 times higher than the recommended dose for a seizuring dog or cat 15 did not result in a report of EG levels that would be considered toxic in dogs or cats. Propylene glycol is also present in other commonly used pharmaceuticals, such as phenobarbital, lorazepam, etomidate, sorbitol, digoxin, and trimethoprim–sulfamethoxazole, 6 and the possibility for a small degree of inaccuracy should be taken into account when using these products. Based on the findings in the current study, the propylene glycol that is used as a carrier for diazepam would not interfere with interpretation of the EG test kit.…”

An Update on Treatment of Drug-Induced Liver Injury

“…While clinicians should be aware of this potential complication, it should not preclude treatment with activated charcoal. 32 Silibinin is universally accepted as a treatment modality for amatoxin poisoning because it inhibits the transfer of amanitin into hepatocytes. It should be administered within 48 hours of mushroom ingestion.…”