From the Guidelines
The treatment approach for suspected mushroom poisoning should prioritize immediate medical attention, supportive care, and specific antidotes such as penicillin G and silibinin, as recommended by the most recent guidelines 1. The initial management includes gastrointestinal decontamination with activated charcoal (50-100g for adults, 1-2g/kg for children) if the patient presents within 1-2 hours of ingestion. Intravenous fluid resuscitation is crucial to maintain hydration and electrolyte balance. For Amanita phalloides poisoning, specific treatments include:
- High-dose penicillin G (300,000-1,000 units/kg/day) 1
- N-acetylcysteine (loading dose 150 mg/kg over 1 hour, followed by 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours)
- Silibinin (20-50 mg/kg/day divided in 4 doses) if available 1 Severe cases may require liver function monitoring and potentially liver transplantation, as this procedure is often the only lifesaving option 1. For muscarinic symptoms from certain mushrooms, atropine (0.5-2 mg IV for adults, 0.01-0.02 mg/kg for children) may be administered. Treatment duration depends on the type of mushroom and severity of poisoning. This approach targets both toxin removal and mitigation of organ damage, as mushroom toxins can cause liver failure, kidney injury, and neurological effects depending on the species ingested 1. Early intervention significantly improves outcomes in these potentially life-threatening poisonings. Key considerations in treatment include:
- Prompt recognition of mushroom poisoning symptoms, such as severe gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal cramping) 1
- Aggressive supportive care to prevent organ damage
- Use of specific antidotes, such as penicillin G and silibinin, as recommended by guidelines 1
From the Research
Treatment Approach for Suspected Mushroom Poisoning
The treatment approach for suspected mushroom poisoning involves several steps, including:
- Primary detoxification by induced emesis, gastric lavage, and activated charcoal 2
- Secondary detoxification, symptomatic treatment, and rarely specific antidotes 2
- Administration of silibinin and penicillin G, although controlled studies on its therapeutic efficacy are still lacking 2
- Consideration of orthotopic liver transplantation in serious cases of phalloides syndrome 3, 2
- Intensive hemodialysis and hemoperfusion treatment for severe cases 4
- Plasmapheresis for Amanita poisoning patients 5
Diagnosis and Management
Diagnosis of mushroom poisoning is primarily based on:
- Anamnestic data
- Identification of mushrooms from leftovers of the mushroom meal
- Spore analysis
- Chemical analysis 2
- α-amanitin detection in suspected Amanita poisoning patients 5
Prognosis and Outcome
The prognosis in most other mushroom poisonings is excellent, but the mortality rate associated with phalloides syndrome is still high (5-20%) 2 Early detection and treatment can greatly influence the outcomes of Amanita poisoning patients 5 The mortality rate was 7.7% in the detection group and 50.0% in the conventional group, highlighting the importance of early detection and treatment 5