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Poisoning with mushroom poisons of hepatonephrotropic effect

To these poisons we refer phallotoxins and amyotoxins (toadstool or Amanita phalloides), gervelic acid (Gyromitrae), alkaloid arelonin (Cortinarius). Amyotoxins selectively affect a cell nucleus, phallotoxins — hepatocytes, and arelonin — renal cells.

The following periods are distinguished:

— latent period — from 6 hours to 3 days;

— period of gastrointestinal disorders starts suddenly. Usually, patients do not associate, in the first hours, their disease with mushrooms' consumption that leads to hospitalization of such victims to a nonprofile department and waste of time for an adequate treatment. A clinical picture is as follows: nausea, vomiting, diarrhea, pains in the abdomen. A duration of this period is usually 3 days and its gravity is due to a disorder of WEE and intoxication. As a result of noncorrected dehydration and electrolyte disorders may follow fatal outcomes;

— period of phalloid hepatitis lasts 2-3 weeks. It is characterized by sudden cessation of gastrointestinal disorders (false recovery) and progressive advancement of symptoms of hepatic and renal insufficiency. Skin coverings become icteric, hemorrhagic syndrome, pains in the abdomen as a result of growing hepatergia, encephalopathy up to coma and convulsive syndrome are noted. Oligoanuria develops. Death, most often, comes in this period;

— period of outcome (recovery) starts from the moment of subsiding a symptomatology of hepatic and renal insufficiency and lasts from a few months to several years.

Treatment:

1. General principles of therapy of poisonings and preventive treatment.

2. Treatment of enteritis and phalloid hepatitis.

3. Rehabilitation therapy in the period of outcome.

Preventive treatment includes antibiotic therapy in high doses, silibor, lipamide or lipoic acid 15-30 mg/kg.

In gastrointestinal period a dose of antibiotics is decreased to the medium-therapeutic doses, the dose of silibor, lipamide and lipoic acid (in the ratio of 1:2) increases twice, rehydration, parenteral feeding and detoxication are

recommended. A method of choice of detoxication therapy is hemosorption. At the same time, a symptomatic therapy is carried out.

In the period of phalloid hepatitis administration of penicillin is continued in the average therapeutic doses, silibor — in usual dosage, and lipamide and lipoic acid are prescribed within the range of 30-60 mg/kg/day already in the ratio of 2:1,and acetylcysteine. Infusion therapy to normalize homeostasis and parenteral feeding, glucocorticoids, hydrocortisone — from 5 to 20 mg/kg/day, detoxication and symptomatic therapy are recommended.

A method of efferent treatment is hemosorption, plasmapheresis. In the period of outcome a hepatoprotective therapy (carsil, alpha-tocopherol, etc.) is carried out up to 3 months for a course.

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