Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning.
BACKGROUND
Ingestion of Amanita phalloides is the most common cause of lethal mushroom poisoning. The relative late onset of symptoms is a distinct diagnostic feature of Amanita intoxication and also the main reason of failure for extracorporeal removal of Amanita-specific toxins from the gut and circulation.


METHODS
Extracorporeal albumin dialysis (ECAD) has been used on six consecutive patients admitted after A. phalloides poisoning with acute liver failure (ALF).


RESULTS
Six patients, with mean age of 46 years (range: 9-70 years), underwent one to three ECAD treatments. The mean time from mushroom ingestion until the first ECAD treatment was 76 h. Two patients regenerated spontaneously under ECAD treatment and orthotopic liver transplantation (OLT) could be avoided. Two patients were successfully bridged to OLT and one patient died because of cerebral herniation. One patient was treated with ECAD immediately after OLT because of the graft dysfunction and survived without re-transplantation.


CONCLUSIONS
ECAD appeared to be a successful treatment perspective in supporting liver regeneration or in sufficient bridging to OLT and also in treatment of graft dysfunction after OLT in patients with A. phalloides poisoning.
Faybik
Peter
P
Department of Anesthesia and Intensive Care Medicine, University Hospital, Vienna, Austria. zralok@hotmail.com
Hetz
Hubert
H
Baker
Amir
A
Bittermann
Clemens
C
Berlakovich
Gabriela
G
Werba
Alois
A
Krenn
Claus-Georg
CG
Steltzer
Heinz
H
D000328:Adult; D000368:Aged; D000418:Albumins; D000545:Amanita; D002648:Child; D005112:Extracorporeal Circulation; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000628:therapy*; D006435:Renal Dialysis; D016060:Sorption Detoxification; D013997:Time Factors
D000418:Albumins