Physical examination, serum biochemical, and coagulation abnormalities, treatments, and outcomes for dogs with toxicosis from α-amanitin–containing mushrooms: 59 cases (2006–2019)

Abstract

OBJECTIVE To report history, physical examination findings, clinicopathologic abnormalities, treatments, and outcomes of dogs with confirmed α-amanitin toxicosis resulting from ingestion of α-amanitin–containing mushrooms, and to report whether any differences were significant between survivors and nonsurvivors. ANIMALS 59 dogs. PROCEDURES Medical records of all dogs with confirmed α-amanitin toxicosis presented to a northern California emergency and specialty veterinary hospital between January 2006 and July 2019 were reviewed for signalment; body weight; history; physical examination findings including rectal temperature at presentation; results of serum biochemical analyses, coagulation tests, and a test for the detection of α-amanitin in urine; treatments; and outcomes. Differences for each were compared between survivors and nonsurvivors. RESULTS Among the 59 dogs, 36 were < 1 year of age; 56 had variable clinical signs that included vomiting, diarrhea, anorexia, and weakness or lethargy; and 22 had rectal temperatures > 39.2°C (102.5°F) at presentation. Cases were seen throughout the calendar year. At presentation, alanine aminotransferase activity was mildly to markedly increased in 97% of dogs, hypoglycemia was noted in 78%, and coagulation times were prolonged in 91%. Most dogs that rapidly decompensated died; however, 13 dogs survived to hospital discharge and completely recovered. CONCLUSIONS AND CLINICAL RELEVANCE Ability to recognize dogs with α-amanitin toxicosis on the basis of clinical signs, physical examination findings, and clinicopathologic test results is essential because mushroom ingestion is rarely observed and immediate treatment is necessary. Dogs that have marked hypoglycemia or coagulopathy may have a poor prognosis.

Early diagnosis of amanitin exposure (amatoxicosis) in a dog with a point‐of‐care diagnostic test

“…Dextrose support is also an important component of supportive therapy in amatoxicosis. In a case review of 59 dogs suffering from amatoxicosis, 95% developed hypoglycemia 1 . Fresh frozen plasma, which is frequently used as part of the treatment protocol in cases of amatoxicosis, 1,18 was not indicated in this dog, as a coagulopathy was not documented.…”

“…6 Gastrointestinal signs of vomiting and diarrhea develop 6-24 hours after ingestion of the mushroom, followed by a convalescent phase, and then progression toward hepatic failure and multiorgan dysfunction syndrome. While these distinct phases of illness are not always identified in dogs that present to the emergency clinic, 1 it is important to recognize that there is a delay in clinical signs following ingestion of the toxin. Although the plasma half-life of amanitins in dogs is only 25-50 minutes, amanitins should be detectable in the urine for up to 72 hours.…”

“…Depending on the dose, liver failure and eventually death may occur. In a retrospective case review of 59 dogs with amatoxicosis, only 26% of treated patients survived 1 …”

“…Currently, a presumptive diagnosis of amatoxicosis in dogs is made when there is a history of possible exposure and consistent clinical signs and biochemical changes. It is rare that an owner has actually witnessed their dog eating a mushroom 1 and often identification of the mushroom is not possible because expertise in species identification is not readily available or because the material is fragmented or only available in vomitus. Clinical signs of amatoxicosis include vomiting, lethargy, fever, hepatopathy, and hypoglycemia.…”

“…[7][8][9][10][11][12] Currently, a presumptive diagnosis of amatoxicosis in dogs is made when there is a history of possible exposure and consistent clinical signs and biochemical changes. It is rare that an owner has actually witnessed their dog eating a mushroom 1 and often identification of the mushroom is not possible because expertise in species 1). The key differences in these A LFIA point-of-care (POC) test for amanitin detection 13 has been developed and is now commercially available and inexpensive (US $10 [USD] per test) (Figure 2).…”