Severe mushroom poisoning due to amatoxin in children

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Objectives

Mushroom poisoning is characterized by a very variable clinical picture. The amatoxins, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. The authors present the clinical picture of the phalloid syndrome and its treatment.

Methods

Within a period of four years, 12 children with mean age of 10.75 years (4.5-16 years) including 6 males and 6 females with severe Amanita mushroom poisoning were treated at the PICU. The severity of poisoning was graded according to serum transaminase elevations and prolongation of prothrombin time. The diagnosis was based on anamnestic data, the clinical picture and, in the some patients, on mycological examinations of mushrooms residues, and their spores.

Results

The mean duration of hospitalization in the PICU was 8 days (3-19). 11/12 patients improved and were discharged from the hospital asymptomatic, one patient died. Our protocol for conservative treatment consisted of: fluid and electrolyte replacement, oral activated charcoal and lactulose, i.v. penicillin G, all patients received i.v. thioctic acid and i.v. silibinin, all received a special diet, and some patients received frozen fresh plasma and IV Fibrinogen. 3/12 children were given conservative therapy with hemodialysis and hemoperfusion This combination of treatment modalities was used to accelerate the elimination of amatoxin from the patients' bodies. The mean time between the consumption of the mushrooms and the first gastrointestinal symptoms was 9.84 h (4-18) and the mean time between the consumption and the admission to the hospital (the start of therapy) was 28 h (4-72). The duration of therapy according to the protocol of conservative therapy was 5.45 days (3.5-7.5). The increased liver enzymes SGPT and SGOT were found in 10/12 patients. In 7/12 patients the prothrombin time was prolongated. In 3/12 patients we used hemoperfusion combined with hemodialysis and in 2/12 plasmapheresis.

Conclusions

We conclude that intensive combined treatment applied in our patients is highly effective in improving patients with both moderate and severe amanitin poisoning.