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Treatment of poisoning by amanita

Today I shall maybe saving the life of someone you know.  I might be saving your life but I assume that if you have the kind of mind that doesn’t mind wading through my writing then you are probably capable of making sure you don’t need saving.  Or if you are going to be killed then it will be by some means that I have no power to save you from.

 

I read today of one of the country’s first mushroom fatalities of the year.  Reportedly the culprit was amanita phalloides, the death cap mushroom.  The coroner passed a verdict of misadventure saying that there was nothing that could have been done, even had she been taken directly to hospital at the first indication of trouble.  The woman affected was very ill and there was no transplant organ available to replace the damaged one.

 

This struck me as being a somewhat political verdict.  Admittedly amanitas are fatal a lot of the time and admittedly there is very little knowledge about how their harm may be prevented.  However I felt the verdict was largely to protect the doctor that had been consulted at first instance.  Most doctors will probably never come across a case of amanita poisoning and if they do it is probable they will never do so again.  Due to this it is hardly surprising that most cases end in death.  There are a few treatments that are beginning to come to light but our ability to find more is probably scuppered by the fact that people rather sensibly do not eat all that many death cap mushrooms.

 

The first is that proposed by Doctor Bastien which has been used with a remarkable level of success since 1957 on the continent.  Dr Bastien has even had so much faith in his technique as to consume fatal quantities of amatoxins on two separate occasions in order to prove that it works.

 

“The treatment consists of giving, as soon as possible, intravenous vitamin C (ascorbic acid) 3 g/d, oral nifuroxazide 1200 mg/d and-dihydrostreptomycin 1500 mg/d. The three drugs are administered for 3 days during which time carrot broth is the only source of nutrition.  At the anti-toxic centres in France this treatment is combined with ‘the indispensable reequilibration of fluids and electrolytes and a course of penicillin.”

 

Beyond the mention of vitamin C I have little idea of what the substances are, but the important thing to remember is that this treatment appears to do the trick.  So much so that Dr Bastien is prepared to risk his life to prove it.

 

The second treatment is one which seems far more likely to become available in England.  The principle involved is that when the amatoxins enter the system they are processed by the liver, which is damaged by their presence.  The liver passes the amatoxins back out into the bloodstream but sadly some time later they once again enter the liver to try and finish off the damage they earlier began.  The only way out of this cycle is to have faith in the kidneys.  The kidneys have the ability to actually send the amatoxins out of the system so they can no longer do any harm.  The problem is that in order for the kidneys to do their job they need to be kept sufficiently hydrated.  The process is so lengthy that they often become dehydrated and death results.  The primary part of this treatment is therefore to keep the kidney’s hydrated.  In order to do this just make sure you get enough water.  Sadly many hospital treatments that are tried before the hospital realises what is going on will lead to further dehydration, e.g. pumping the stomach, which is ineffectual anyway as the poison has already moved on if it is causing damage.

 

The second part of the treatment is a substance called silibinin.  This is given intravenously and has the effect of maintaining the liver during this trialling time.  The substance is originally obtained from the milk thistle plant, silybum marianum, so if it is not possible to get to a  hospital on time then that would have to be your last/first resort as an alternative to being given medication.  Whatever happens always maintain your water intake to give as much support to your kidneys as possible.


There are other options such as plasmapheresis to cleanse your blood or an organ transplant if things have gone that far, which they do, very rapidly.  The most important and obvious way to avoid any complications though is to never eat any death caps, destroying angels, or galeriana’s.  If you do discover that you have been unlucky enough to have done so then make sure that before anything else you tell the doctor of this suspicion because these poisonings are rare and it is unlikely your doctor will realise this is what is ailing you if he is not told of the possibility.

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