Haemoperfusion in Amanita phalloides Poisoning

Abstract

Amanita phalloides is responsible for about 90 per cent of all fatal cases of mushroom intoxication. The amatoxins, the main toxic component of these fungi, are responsible for gastro-intestinal symptoms as well as hepatic and renal failure. Three brothers with Amanita phalloides poisoning were admitted with gastro-intestinal symptoms beginning 12 h after ingestion. Jaundice, hepatomegaly and neurological symptoms were not present, but liver enzymes were moderately increased. Alfa-amanitin was detected in sera of all patients. All patients underwent charcoal hemoperfusion and two of them had additional hemodialysis along with conservative therapy. Liver enzymes that showed a marked increase on the second day of therapy decreased to normal levels on the 28th day. All of our patients survived. This life saving role of early haemoperfusion in Amanita phalloides poisoning is emphasized.

Experience of Treatments of Amanita phalloides–Induced Fulminant Liver Failure with Molecular Adsorbent Recirculating System and Therapeutic Plasma Exchange

“…Early hemoperfusion (<24 hours after exposure) over a charcoal filter is effective in averting the deleterious effects of amatoxins. 16 Because of the rapid time course of absorption and excretion of amatoxins, hemodialysis will have a limited effect, even if applied within 24 hours of consumption. 17,18 Molecular adsorbent recirculating system is capable of transferring protein-bound and water-soluble toxic metabolites from the blood stream into a dialysate compartment via a special membrane, 14 effectively functioning as an artificial liver for acute liver failure.…”

Experience of Treatments of Amanita Phalloides-induced Fulminant Liver Failure with Molecular Adsorbent Recirculating System and Therapeutic Plasma Exchange

“…Several studies have suggested that early hemoperfusion (<24 hours after exposure) over a charcoal filter is effective in averting the deleterious effects of amatoxins and should be considered (16). Hemodialysis may also be used; however, because of the rapid time course of the absorption and excretion of amatoxins, hemodialysis will have a limited effect, even if applied 24 hours after consumption (17)(18).…”

Mushroom poisoning

“…The importance of early hemoperfusion in amanita poisoning has been emphasized in many studies. 15,20,21 In one study it is shown that early hemoperfusion by itself or together with hemodialysis and plasmapheresis decrease mortality due to renal and hepatic failure to a great extent. 22 More recently, MARS seems to be the most promising dialysis method as in many studies its efficacy is referred to in treatment of mushroom poisoning even in cases with severe hepatic dysfunction and encephalopathy.…”