Indication of liver transplantation following amatoxin
Prompt identification of mushroom-related toxic symptoms in the ED and early, aggressive IV volume replacement are critical first steps in diminishing the significant morbidity and mortality associated with amatoxin ingestion.
Legalon[R] SIL: the antidote of choice in patients with acute hepatotoxicity from amatoxin poisoning.
dagger]) Silibinin dihemisuccinate, a milk thistle extract, competitively inhibits hepatic amatoxin uptake and enterohepatic recycling, and is available in the United States through an open clinical trial.
Amatoxins, the principal toxic alkaloids found in these fungi, cause cell injury by halting protein synthesis.
Octreotide, by preventing emptying of the gallbladder, might reduce recirculation of amatoxins in bile to the liver.
Administration of cimetidine, a cytochrome P-450 inhibitor which inhibits the uptake of amatoxins
by the mixed function oxidase system, and N-acetylcysteine (NAC), a glutathione precursor that binds amatoxin
-related free radicals, have also been used in the treatment of amanitin intoxication.
No correlation exists between the plasma amatoxin concentration and clinical outcome, nor does the amount of liver-bound toxin correlate with the plasma concentration.
Silymarine (from the milk thistle Silibum marianum) exerts its protective effect after intravenous administration in various ways: (a) by interrupting the enterohepatic recirculation of amanitin; (b) by inhibiting the binding of toxins to hepatocyte membranes; (c) by competing with amatoxin for transmembrane transport; and (d) by inhibiting the penetration of amanitin into liver cells (1).
Amatoxins, which constitute the second group of Amanita toxins, are cyclic octapeptides that interfere with DNA transcription (3).
3 mg/kg (8), and phallotoxins seem to exacerbate the action of amatoxins.