Management of Amanita phalloides poisoning: A literature review and update

Amanita phalloides poisoning: one harvest, three outcomes

“…The severity of A. phalloides poisoning depends on the amount of toxin ingested (as little as 0.1 mg/kg of amatoxin may be lethal) and the time elapsed between consumption and starting of specific treatment. 7,12 Since the initial symptoms can be attributed to a simple gastroenteritis episode, there may be significant delay in seeking medical care especially in developing countries where lack of education, poor access to health care and cost are big barriers.…”

“…The management principles include supporting vital functions, preventing amatoxin absorption, eliminating absorbed amatoxins, using potential antidotes and early involvement of the liver transplant unit. 12 Preventing amatoxin absorption can be achieved by either gastric lavage or use of activated charcoal. Effectiveness of gastric lavage depends on the time between ingestion and presentation (ideally within 1 hour).…”

“…The recommended charcoal dose is 50 g every 4 hours. 12 Out of all the absorbed amatoxins, 60% is excreted via bile and 40% renally. Amatoxins can still be found in urine 4 days after ingestion and therefore ensuring adequate diuresis is recommended.…”

“…Percutaneous biliary drainage has also been shown to help by interrupting the enterohepatic circulation. 12 Where available, extracorporeal elimination techniques were also found to be useful if started early. Plasmapheresis, haemodialysis and charcoal plasma haemoperfusion, Molecular Adsorbent Recirculating system (MARS) and Fractionated plasma separation and absorption (FPSA) are among the modalities used in amanitin poisoning, with variable success.…”

Acute Liver Failure

“…87 In specialized centers, further therapeutic modalities for critical ALF patients include the application of artificial liver support devices such as MARS (molecular adsorbent recirculating system) or fractionated plasma separation and adsorption. 57,[88][89][90] In general, MARS and fractionated plasma separation and adsorption might have the potential to increase the probability of short-term survival of patients with ALF or ACLF and can be introduced for bridging to liver transplantation; 91 MARS therapy seems to successfully replace hepatic function in ALF, thereby allowing time for spontaneous recovery or transplantation. 92 Both approaches, however, are not appropriate for long-term therapy; 91 MARS in patients with ALF failed to show a survival improvement in the overall study cohort.…”