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Toxicity, Mushroom - Amatoxin: Differential Diagnoses & Workup
Updated: Nov 9, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Workup
Laboratory Studies
- Obtain liver function tests because hepatic damage is the main concern with amatoxin poisoning.
- Prothrombin time (PT) (most reliable indicator for severity of poisoning)
- Aminotransferase levels
- Bilirubin level
- Alkaline phosphatase level
- Complete blood count (CBC)
- Electrolytes, BUN, and creatinine levels (dehydration from vomiting and diarrhea)
- Glucose level (monitor very closely with hepatic failure)
- Urinalysis (hematuria and proteinuria signifying renal involvement)
- Amylase/lipase level (pancreatitis)
- Serum ammonia level in patients with evidence of hepatic encephalopathy
- Urinary amanitin analysis (a pilot study suggests high specificity and positive predictive value) is not clinically feasible in most cases.
Imaging Studies
- Abdominal radiographs may be obtained if bowel obstruction or ileus appears in the differential diagnosis. Mushrooms are not radiopaque and, therefore, will not be seen on abdominal radiographs.
Other Tests
- Melzer reagent in contact with amatoxin containing mushroom produces a dark blue color
- Meixner test also can be performed if a specimen of the ingested mushroom is available for analysis. However, false-negative and false-positive tests are raising the question of its reliability.
- Place a drop of liquid expressed from the mushroom on lignin-containing paper (ie, paper derived from wood pulp, such as newspaper but not filter paper).
- After the drop has dried, place a drop of 10-12 N HCl on the spot.
- The appearance of a blue color within several minutes suggests the presence of amatoxins.
- A delayed appearance of a blue color suggests that amatoxin is present but in lower concentrations.
- Presence of psilocybin can lead to a false-positive result.
- Gastric contents are not suitable for this test.
- An experienced mycologist may analyze and identify spores in gastric contents.
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 Differential Diagnoses & Workup: Toxicity, Mushroom - Amatoxin |
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References
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Further Reading
Keywords
amatoxin toxicity, death cap, mushroom ingestion, poisonous mushroom, mushroom toxicity, mushroom poisoning, amatoxin, toxin, cyclopeptide-containing species, amatoxin poisoning, mushroom exposure,
