Pediatric Amatoxin Toxicity Follow-up

  • Author: Douglas S Lee, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Mar 30, 2012
 

Further Inpatient Care

  • Admit all cases of patients with A phalloides mushroom poisoning and observe for progression to later stages.
  • Continue vigorous intravenous (IV) hydration and gastric decontamination.
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Further Outpatient Care

  • Patients who remain asymptomatic for 12 hours after ingestion of unknown mushrooms may be safely discharged.
  • Monitor the following laboratory studies for signs of deterioration:
    • Liver function tests
    • Electrolytes and glucose levels
    • BUN and creatinine levels
    • Prothrombin time
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Transfer

  • Consider transferring any symptomatic patient to a facility with liver transplant capability to minimize delays in procuring an appropriate organ.
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Deterrence/Prevention

  • Closely monitor young children in rural or suburban areas.
  • Educate mushroom pickers of the dangers of amateur mushroom hunting.
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Complications

  • Various studies have shown that some who recover from acute liver failure may go on to develop chronic liver disease.
  • The mechanism of development of related chronic liver disease is unknown but changes in hepatocyte structure may induce autoimmunity, leading to chronic hepatitis with potential progression to end-stage liver disease.
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Prognosis

  • Prognosis is most likely determined by the quantity of mushroom that was eaten.
  • A variation in individual susceptibility to the toxin has been reported.
  • Children absorb a larger dose of toxins per kilogram of body weight and have a higher mortality than adults.
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Patient Education

  • Educate the patient of the dangers of amateur mushroom hunting.
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Contributor Information and Disclosures
Author

Douglas S Lee, MD  Attending Physician, Department of Emergency Medicine, Naples Community Hospital

Douglas S Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Suzanne Bentley, MD  Clinical Instructor, Department of Emergency Medicine, Elmhurst Hospital, Mount Sinai School of Medicine

Suzanne Bentley, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Women's Association, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Theodore Bania, MD  Program Director, Assistant Director of Research, Department of Emergency Medicine, Division of Toxicology, Assistant Professor, St Luke's-Roosevelt Hospital Center, Columbia University

Theodore Bania, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, New Mexico Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Matthew R Denny, MD, MPH  Staff Physician, Department of Emergency Medicine, Santa Clara Valley Medical Center; Clinical Instructor, Department of Emergency Medicine, Stanford University School of Medicine

Matthew R Denny, MD, MPH is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Mullins, MD  Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

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Amanita muscaria.
Amanita phalloides.
 
 
 
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