[The wrong mushroom. Diagnosis and therapy of mushroom poisoning, especially of Amanita phalloides poisoning]

Abstract

By far the most frequent deadly intoxication with mushrooms is caused by Amanita phalloides. The diagnosis is based upon the long latency phase, the typical clinical picture of which includes four periods (the asymptomatic latent phase, the gastroenteritis phase, the oligosymptomatic interval and the hepatorenal phase), analysis of the mushrooms by the expert and the sensitive radioimmunoassay for amanitin in blood, urine or gastric content. The therapy includes (1) stabilisation of the patient with the correction of hypoglycemia and electrolyte imbalance, substitution with coagulation factors (FFP) and red cells and the treatment of septic complications, (2) decontamination, which consists of gastric lavage, the administration of activated charcoal and laxatives as well as the forced diuresis, and (3) therapy with high doses of penicillin or ceftazidime and of silibinine. The pathophysiological mechanisms are discussed. The other important types of mushroom intoxications are summarized in Table 1.