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      Falla hepática aguda y otros trastornos causados por el consumo de Amanita phalloides

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          Abstract

          Resumen:A pesar de ser una patología rara la intoxicación por hongos puede llegar a ser potencialmente mortal, principalmente si se habla del Amanita phalloides, el cual contiene toxinas capaces de producir alteraciones gastrointestinales y falla hepática aguda. La amatoxina, uno de sus componentes es letal a dosis de 0.1 mg/kg y el manejo posterior a su ingesta no cuenta con pautas claramente establecidas, el mismo va a depender del tiempo que haya transcurrido desde la ingesta del hongo y puede llegar a ser tan invasivo como un trasplante hepático.

          Translated abstract

          Abstract:Despite it is a rare disease, the fungus poisoning can be lethal, mainly if it is with Amanita phalloides. This fungus have toxins that produce gastrointestinal alterations and acute liver failure. The amatoxin is one of its main components, its letal dosis is 0,1mg/kg and it doesn't have a established treatment, the outcome depends of the elapsed time between the ingest of the fungus and the medical treatment, which can be even a liver transplant.

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          Mushroom poisoning: retrospective analysis of 294 cases

          OBJECTIVE The objective of this study was to present special clinical and laboratory features of 294 cases of mushroom poisoning. MATERIALS AND METHODS In this retrospective study, 294 patients admitted to the Pediatric and Adult Emergency, Internal Medicine and ICU Departments of Cumhuriyet University Hospital were investigated. RESULTS Of 294 patients between the ages of 3 and 72 (28.97 ± 19.32), 173 were female, 121 were male and 90 were under the age of 16 years. One hundred seventy-three patients (58.8%) had consumed the mushrooms in the early summer. The onset of mushroom toxicity symptoms was divided into early (within 6 h after ingestion) and delayed (6 h to 20 d). Two hundred eighty-eight patients (97.9%) and six (2.1%) patients had early and delayed toxicity symptoms, respectively. The onset of symptoms was within two hours for 101 patients (34.3%). The most common first-noticed symptoms were in the gastrointestinal system. The patients were discharged within one to ten days. Three patients suffering from poisoning caused by wild mushrooms died from fulminant hepatic failure. CONCLUSION Education of the public about the consumption of mushrooms and education of health personnel working in health centers regarding early treatment and transfer to hospitals with appropriate facilities are important for decreasing the mortality.
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            Legalon® SIL: The Antidote of Choice in Patients with Acute Hepatotoxicity from Amatoxin Poisoning

            More than 90% of all fatal mushroom poisonings worldwide are due to amatoxin containing species that grow abundantly in Europe, South Asia, and the Indian subcontinent. Many cases have also been reported in North America. Initial symptoms of abdominal cramps, vomiting, and a severe cholera-like diarrhea generally do not manifest until at least six to eight hours following ingestion and can be followed by renal and hepatic failure. Outcomes range from complete recovery to fulminant organ failure and death which can sometimes be averted by liver transplant. There are no controlled clinical studies available due to ethical reasons, but uncontrolled trials and case reports describe successful treatment with intravenous silibinin (Legalon® SIL). In nearly 1,500 documented cases, the overall mortality in patients treated with Legalon® SIL is less than 10% in comparison to more than 20% when using penicillin or a combination of silibinin and penicillin. Silibinin, a proven antioxidative and anti-inflammatory acting flavonolignan isolated from milk thistle extracts, has been shown to interact with specific hepatic transport proteins blocking cellular amatoxin re-uptake and thus interrupting enterohepatic circulation of the toxin. The addition of intravenous silibinin to aggressive intravenous fluid management serves to arrest and allow reversal of the manifestation of fulminant hepatic failure, even in severely poisoned patients. These findings together with the available clinical experience justify the use of silibinin as Legalon® SIL in Amanita poisoning cases.
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              Acute liver failure caused by mushroom poisoning: a case report and review of the literature

              It is estimated that there are over 5,000 species of mushrooms worldwide. Some of them are edible and some are poisonous due to containing significant toxins. In more than 95% of mushroom toxicity cases, poisoning occurs as a result of misidentification of the mushroom by an amateur mushroom hunter. The severity of mushroom poisoning may vary, depending on the geographic location where the mushroom is grown, growth conditions, the amount of toxin delivered, and the genetic characteristics of the mushroom. Amanita phalloides is the most common and fatal cause of mushroom poisoning. This mushroom contains amanitins, which are powerful hepatotoxins that inhibit RNA polymerase II in liver. Mushroom poisoning is a relatively rare cause of acute liver failure. A 63-year-old male patient was admitted to the emergency room with weakness, nausea, vomiting, and diarrhea. He reported ingesting several wild mushrooms about 36 hours earlier. In this article we report a case of lethal Amanita phalloides intoxication from stored mushrooms.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                mlcr
                Medicina Legal de Costa Rica
                Med. leg. Costa Rica
                Asociación Costarricense de Medicina Forense
                1409-0015
                March 2016
                : 33
                : 1
                : 96-102
                Affiliations
                [1 ]
                [2 ]
                Article
                S1409-00152016000100096
                80470759-1ff9-4c16-b15c-8c16e015f6ef

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                SciELO Costa Rica

                Self URI (journal page): http://www.scielo.sa.cr/scielo.php?script=sci_serial&pid=1409-0015&lng=en
                Categories
                Anatomy & Morphology
                Medicine, Legal

                Social law,Anatomy & Physiology
                Falla hepática aguda,Amanita phalloides,amatoxinas,Active liver failure,amatixines

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