[Therapy of Amanita phalloides poisoning. Results of clinical and experimental studies]

Abstract

On the basis of experimental and clinical results evidence accumulates that supportive therapy is still the milestone in the therapy of death cap poisoning. Today the letality is 20%. The main cause of the intoxication are the amatoxines which inhibit DNA dependent RNA Polymerase II or B. Parts of the supportive therapy are: diuresis with 150--200 ml urin/hour, careful corrections of disturbances in electrolyte and acid-base-metabolism, oral administration of charcoal and oral gut sterilization. In spite of a multitude of experimental and clinical reports on the effectivity of Penicillin G, thiocticacid and steroids there are no controlled studies to demonstrate the advantage of one regimen over the other. The time course of resorption and excretion of amatoxines clearly shows that hemoperfusion and/or hemodialysis are only of value if applied within the first 24 hours after poisoning. At this time neither anamnestic nor biochemical data give any clues to the probable course of the disease. Heterologous baboon liver perfusion may be lifesaving in coma hepaticum grade IV, but the small amount of cases so far does not yet allow any comments on its effectivity.