Pediatric Amatoxin Toxicity Treatment & Management

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

Medical Care

  • Early management of airway, breathing, and circulation (ABCs) and intravenous (IV) access is important in patients with mushroom poisoning. Supportive care with IV hydration and correction of electrolyte abnormalities leads to symptomatic improvement.
  • If the patient presents less than 1 hour after known ingestion of cyclopeptide-containing mushrooms, consider gastric decontamination via gastric lavage, vomiting, or nasoduodenal suctioning. Patients who present with nausea and vomiting within 1-2 hours of ingestion of a mushroom most likely have consumed a less toxic mushroom.
  • Secondary detoxification by forced diuresis with sodium bicarbonate has also been recommended and may eliminate 60-80% of total urinary alpha amanitin in the first 2 hours.
  • Administer activated charcoal in patients who are asymptomatic with suspected Amanita ingestion. Patients who are asymptomatic with ingestions of unknown or unidentified mushrooms may receive activated charcoal and observation for 6-12 hours. Most patients with confirmed Amanita poisoning arrive later than 6 hours after ingestion and are usually vomiting at presentation, which may obviate the need for ipecac or lavage. Activated charcoal (1 g/kg) is recommended once vomiting ceases. Multidose activated charcoal or whole bowel irrigation (WBI) may be helpful in disrupting the enterohepatic circulation.
  • Hemodialysis and hemoperfusion have been proposed as methods to remove circulating amatoxin from the blood. Clear recommendations cannot be made, but hemodialysis may be necessary in those patients who develop renal failure.
  • The Molecular Adsorbent Recirculation System (MARS), a form of hepatic albumin dialysis, may have a role in bridging critically ill patients to liver transplantation or to spontaneous recovery of liver function.
  • The efficacy of all above treatment options is primarily based on case reports and small case series.
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Surgical Care

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Consultations

  • Regional poison control center
  • Expert mycologist or local mycological society
  • Transplant center
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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.

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Amanita phalloides.
 
 
 
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