From activated charcoal to selective plasma exchange: A retrospective analysis of mushroom poisoning cases treated in the intensive care unit

Abstract

BackgroundThis study aims to evaluate the treatment modalities of adult patients presenting with mushroom poisoning treated in the intensive care unit (ICU) with special consideration of extracorporeal liver support systems. Material and MethodsRecords of patients with mushroom poisoning treated in the ICU between January 2007 and December 2014 were analyzed retrospectively. Results Sixteen adult patients were treated in the ICU for mushroom poisoning during the designated study period. Average time from ingestion of mushrooms to first symptoms was 17.81 hours, and to ICU admission was 2.38 days. In cases with elevated liver transaminases, penicillin G, silibinin and N-acetyl cysteine were used. Extracorporeal support systems were used for detoxification and as a bridge to liver transplantation in 9 cases. Of these, 4 were plasmapheresis, 3 were selective plasma exchange, 1 was hemoperfusion and 1 was direct adsorption from plasma. Two cases underwent emergency liver transplantation. Conclusions Liver transplantation is the most definitive and effective treatment in indicated cases of mushroom poisoning. Extracorporeal support systems should be considered in the early period both as a treatment modality on their own or to save time until the definitive treatment is possible. The question of which extracorporeal detoxification technique to use is difficult to answer and controlled clinical trials which compare their efficacy are needed.