In a 3 year period (1975-77) 50 patients have been admitted to the I.C.U. of Polyclinic Hospital of Milan for poisoning from mushrooms of Amanita genus. In 47 cases the diagnosis was confirmed "a posteriori" by serum or urinary detection of amatoxins and/or by clinical evidence of typical liver injury. Besides the symptomatologic support, the therapeutic treatment included combined removal procedures, such as peritoneal dialysis, plasmapheresis, forced diuresis. The detection by radioimmunoassay of amatoxins [6] in the serum and in the urine of these patients proves that this therapeutic treatment can be effective within about 36 hours from ingestion time. The intensive medical care and the removal approach yielded as the whole favourable results in our patients (overall mortality was 6 patients, i.e. 12,7%). It should moreover be emphasized that of the 35 patients, who had been treated with early removal techniques, 12 with ascertained amanita poisoning, had neither clinical nor biochemical evidence of hepatic damage; 14 had a moderate liver damage; 9 experienced a severe liver failure and hepatic coma occurred in 4 of the latter. These poor results can be ascribed to the severity of the poisoning as well as to a peculiar kinetic of amatoxins in each subject.

Die frühzeitige Elimination der Amanita Toxine in der Therapie der Knollenblätterpilzvergiftung = The early removal of amatoxins in the treatment of amanita phalloides poisoning / M. Langer, S. Vesconi, G. Iapichino, D. Costantino, D. Radrizzani. - In: KLINISCHE WOCHENSCHRIFT. - ISSN 0023-2173. - 58:3(1980), pp. 117-123. [10.1007/BF01477268]

Die frühzeitige Elimination der Amanita Toxine in der Therapie der Knollenblätterpilzvergiftung = The early removal of amatoxins in the treatment of amanita phalloides poisoning

M. Langer
Primo
;
G. Iapichino;
1980

Abstract

In a 3 year period (1975-77) 50 patients have been admitted to the I.C.U. of Polyclinic Hospital of Milan for poisoning from mushrooms of Amanita genus. In 47 cases the diagnosis was confirmed "a posteriori" by serum or urinary detection of amatoxins and/or by clinical evidence of typical liver injury. Besides the symptomatologic support, the therapeutic treatment included combined removal procedures, such as peritoneal dialysis, plasmapheresis, forced diuresis. The detection by radioimmunoassay of amatoxins [6] in the serum and in the urine of these patients proves that this therapeutic treatment can be effective within about 36 hours from ingestion time. The intensive medical care and the removal approach yielded as the whole favourable results in our patients (overall mortality was 6 patients, i.e. 12,7%). It should moreover be emphasized that of the 35 patients, who had been treated with early removal techniques, 12 with ascertained amanita poisoning, had neither clinical nor biochemical evidence of hepatic damage; 14 had a moderate liver damage; 9 experienced a severe liver failure and hepatic coma occurred in 4 of the latter. These poor results can be ascribed to the severity of the poisoning as well as to a peculiar kinetic of amatoxins in each subject.
In einer 3 Jahresperiode (1975–77) wurden an der Intensivpflegestation des Krankenhauses Ospedale Maggiore Policlinico in Mailand 50 Patienten mit der Verdachtsdiagnose einer Knollenblätterpilzvergiftung stationär aufgenommen. Für 47 dieser Patienten wurde die Diagnose a posteriori durch positiven Nachweis der Amatoxine in Serum oder Urin und/oder typische Leberzellnekrose bestätigt. Im Therapieschema waren neben unspezifischer Therapie verschiedene Möglichkeiten zur forcierten Elimination der Amanita Toxine vorgesehen (Peritonealdialyse, Plasmapherese, forcierte Diurese). Im selben Patientengut wurde durch FIUME und Mitarb. [6] der erste radioimmunologische Amatoxinnachweis im Serum (1975) und im Urin (1976) erbracht, wodurch die Möglichkeit einer solchen Therapie innerhalb einer Zeitspanne von ungefähr 36 Stunden nach der Pilzmahlzeit bestätigt wurde. Dank allgemeiner Intensivpflegemaßnahmen und Eliminationstherapie waren die Ergebnisse mit einer Mortalität von 12.7% (n=6) insgesamt relativ günstig; von besonderer Bedeutung aber erscheint, daß in der Gruppe mit frühzeitiger Eliminationstherapie (n=35) in 12 Patienten, trotz gesicherter Amanita Vergiftung, ein nennenswerter toxischer Leberschaden verhindert werden konnte, während dieser in 14 Patienten als mittelgradig gewertet wurde. Daß 9 Patienten trotzdem aber schweren Leberzellschaden bis zum Coma hepaticum (n=4) erlitten, mag sowohl auf die Schwere der Vergiftung, als auch auf individuelle Unterschiede in der Kinetik der Amanita Toxine zurückzuführen sein. Es ist durchaus möglich, daß auch in solchen Fällen eine frühere, besser und intensiver durchgeführte Eliminationstherapie die Ergebnisse weiterhin verbessern kann.
Amanita phalloides poisoning; Amatoxins; Diuresis forced; Peritoneal dialysis; Pharmacodynamics; Plasmapheresis
Settore MED/41 - Anestesiologia
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/183981
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