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Hepatic failure after mushroom ingestion
Visual Journal of Emergency Medicine 7 (2017) 53–54
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Hepatic failure after mushroom ingestion
MARK
⁎
Ryan Surmaitis , Dilan Patel, David Goldberger, Kristin McCloskey Drexel University College of Medicine, Philadelphia, PA, USA
A R T I C L E I N F O Keywords: Mushrooms Amanita phalloides Amatoxin Hepatic failure
Fig. 1. Amanita phalloides.
A 25 year old male presents to the emergency department with vomiting and diarrhea. The patient is a forager and states he ate several mushrooms earlier. His GI symptoms started 8 h after ingestion. He has no medical problems and does not use medications, tobacco, alcohol, or illicit drugs. Vital signs are normal except for a HR 110. He is vomiting and appears dehydrated. The rest of his exam is normal. His initial labs are within normal reference rage. He is treated with intravenous fluids, antiemetics, and admitted for dehydration and intractable vomiting. The next day his GI symptoms improve. Repeat blood work shows severely elevated AST, ALT, and INR and he is transferred to the ICU. Amanita phalloides (Fig. 1 and 2) contain potentially lethal amatoxins and causes 95% of mushroom-related deaths worldwide. It is important to recognize that the onset of GI symptoms tend to be delayed (3–6 h) when compared with benign mushroom ingestions 1–3.
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Fig. 2. Amanita phalloides. This image requires a photo credit to Dr. John Dawson, Philadelphia PA USA.
Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj.2016.10.006.
Corresponding author. E-mail address: [email protected] (R. Surmaitis).
http://dx.doi.org/10.1016/j.visj.2016.10.006 Received 1 August 2016; Received in revised form 24 October 2016; Accepted 30 October 2016 2405-4690/ © 2016 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 7 (2017) 53–54
R. Surmaitis et al.
2 Tong TC, Hernandez M, Richardson WH, et al. Comparative treatment of alphaamanitin poisoning with N-acetylcysteine, benzylpenicillin, cimetidine, thioctic acid, and silybin in a murine model. Ann Emerg Med. 2007;50(3):282–288. 3 Ward J, Kapadia K, Brush E, Salhanick SD. Amatoxin poisoning: case reports and review of current therapies. J Emerg Med. 2013;44(1):116–121.
References 1 Enjalbert F, Rapior S, Nouguier-soule J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20 year retrospective analysis. J Toxicol Clin Toxicol. 2002;40(6):715–757.
54
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Hepatic failure after mushroom ingestion
MARK
⁎
Ryan Surmaitis , Dilan Patel, David Goldberger, Kristin McCloskey Drexel University College of Medicine, Philadelphia, PA, USA
A R T I C L E I N F O Keywords: Mushrooms Amanita phalloides Amatoxin Hepatic failure
Fig. 1. Amanita phalloides.
A 25 year old male presents to the emergency department with vomiting and diarrhea. The patient is a forager and states he ate several mushrooms earlier. His GI symptoms started 8 h after ingestion. He has no medical problems and does not use medications, tobacco, alcohol, or illicit drugs. Vital signs are normal except for a HR 110. He is vomiting and appears dehydrated. The rest of his exam is normal. His initial labs are within normal reference rage. He is treated with intravenous fluids, antiemetics, and admitted for dehydration and intractable vomiting. The next day his GI symptoms improve. Repeat blood work shows severely elevated AST, ALT, and INR and he is transferred to the ICU. Amanita phalloides (Fig. 1 and 2) contain potentially lethal amatoxins and causes 95% of mushroom-related deaths worldwide. It is important to recognize that the onset of GI symptoms tend to be delayed (3–6 h) when compared with benign mushroom ingestions 1–3.
⁎
Fig. 2. Amanita phalloides. This image requires a photo credit to Dr. John Dawson, Philadelphia PA USA.
Appendix A. Supplementary material Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j.visj.2016.10.006.
Corresponding author. E-mail address: [email protected] (R. Surmaitis).
http://dx.doi.org/10.1016/j.visj.2016.10.006 Received 1 August 2016; Received in revised form 24 October 2016; Accepted 30 October 2016 2405-4690/ © 2016 Elsevier Inc. All rights reserved.
Visual Journal of Emergency Medicine 7 (2017) 53–54
R. Surmaitis et al.
2 Tong TC, Hernandez M, Richardson WH, et al. Comparative treatment of alphaamanitin poisoning with N-acetylcysteine, benzylpenicillin, cimetidine, thioctic acid, and silybin in a murine model. Ann Emerg Med. 2007;50(3):282–288. 3 Ward J, Kapadia K, Brush E, Salhanick SD. Amatoxin poisoning: case reports and review of current therapies. J Emerg Med. 2013;44(1):116–121.
References 1 Enjalbert F, Rapior S, Nouguier-soule J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20 year retrospective analysis. J Toxicol Clin Toxicol. 2002;40(6):715–757.
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