Survival Following Investigational Treatment of Amanita Mushroom Poisoning

Gores, Kathryn M.; Hamieh, Tarek

doi:10.1378/chest.13-1573

Cited by 11 publications

(7 citation statements)

References 22 publications

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“… 14 Silibinin is one of the interesting principal agents that has been extensively studied for amatoxin mushroom poisoning. 3 , 7 , 15 , 16 During the study period, silibinin for intravenous route was not available in Thailand. Thus, the treatment which Ramathibodi Poison Center advised might include oral high dose silymarin (instead of silibinin) combined with other chemotherapies in some patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcome of toxicity from Amanita mushroom poisoning

Trakulsrichai¹,

Sriapha²,

Tongpoo³

et al. 2017

IJGM

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ObjectiveTo describe and analyze the clinical characteristics and outcome of amatoxin poisoning cases.MethodsWe performed a retrospective cohort study of amatoxin poisoning cases from Ramathibodi Poison Center Toxic Exposure Surveillance System, from May 2013 to August 2015.ResultsThere were 30 consultations with a total of 55 poisoning cases. Most cases were male and from the north-east region. Hepatitis, acute kidney injury, jaundice, and coagulopathy accounted for 74%, 46.3%, 44.7%, and 52.8% of the cases, respectively. Almost all of the patients were admitted to the hospital, and the median duration of hospital stay was found to be 4 days. Mortality rate was found to be 27.3%. Most patients (73%) received the treatment including multiple-dose activated charcoal (67.5%), intravenous N-acetylcysteine (87.5%), and benzylpenicillin (45%). In 60% of the cases, the treatment was initiated within 24 h after eating mushrooms. Exchange transfusion and liver transplantation were performed in one severe case. However, this patient died eventually. Because intravenous silybinin is not available in Thailand during the study period, 8 patients received oral silymarin instead. All 8 patients had hepatitis and were treated with high dosage of oral silymarin (5 patients with 4.48 g/day, 2 patients with 1.68 g/day, and 1 patient with 1.4 g/day) for a couple of days. One of these patients died as she received treatment very late; she was treated with silymarin at 1.68 g/day dosage. Thus, the fatality in oral silymarin treatment group was 12.5%. We performed the analysis between the dead and survival groups. We found that in hepatitis, initial and maximum serum aspartate transaminase, initial and maximum serum alanine transaminase, and acute kidney injury were significantly different between the two groups.ConclusionAmanita mushroom poisoning caused high fatalities. Serum transaminase and creatinine were the factors associated with death. Treatment with oral high dose silymarin should be investigated further as one of the principal therapies in amatoxin poisoning.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcome of toxicity from Amanita mushroom poisoning

Trakulsrichai¹,

Sriapha²,

Tongpoo³

et al. 2017

IJGM

View full text Add to dashboard Cite

show abstract

“…5 To facilitate elimination, multi-dose activated charcoal can be used, because the amatoxin undergoes enterohepatic circulation; however, extracorporeal measures, specifically hemodialysis, have unfortunately proven ineffective in eliminating the toxin. 5,6,9 There is no specific antidote, and adjunct pharmacologic therapy focuses on the oxidant effects of the toxin as well as its uptake via hepatic transporters. 10 Many therapies have been studied, with some of the more commonly used options being N-acetylcysteine, β-lactam antibiotics, cimetidine and silibinin.…”

Section: Managementmentioning

confidence: 99%

“…10 Many therapies have been studied, with some of the more commonly used options being N-acetylcysteine, β-lactam antibiotics, cimetidine and silibinin. 5,6,[8][9][10] N-acetylcysteine is used because of its proposed antioxidant and hepatoprotective effects. It is relatively safe, and its potential benefits are generally viewed to outweigh any risks.…”

Section: Managementmentioning

confidence: 99%

“…8 Silibinin therapy has been given intravenously in case reports and appears to be well tolerated. 5,6,8,9 However, it is available in the US only through phase II and III open-label trials as Legalon, and in Canada it is generally not available without a Special Access request form.…”

Section: Managementmentioning

confidence: 99%

“…5,6,[8][9][10] Their theoretical benefit is derived from an understanding of the amatoxin pathophysiology. Evidence to date, which is primarily based on case reports and retrospective analyses of poisonings, is inconclusive, and one murine model showed that all of these treatments were ineffective at limiting hepatic injury.…”

Section: Managementmentioning

confidence: 99%

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