[Liver albumin dialysis (MARS)--treatment of choice in Amanita phalloides poisoning?].
Amanita phalloides is a direct life-threatening poisoning because of acute multiorgan failure. Urgent liver transplantation (LTx) is the last chance to save patient's life in severe cases. In many cases of mushroom poisoning the patient dies because of unavailability of a liver graft. Liver albumin dialysis (MARS) is a promising treatment to bridge the patient to LTx or stabilize his or her condition until spontaneous liver regeneration occurs.


METHODS
Four family members (father, mother and two sons) were eating self-collected mushrooms (Russula vesca). Typically for the Amanita phalloides poisoning, the first symptoms appeared in all persons more than 12 hours after mushroom ingestion. Because they did not improve, the whole family was admitted to the Regional Hospital in Ketrzyn (24 hours after mushroom ingestion). Mycological examination of gastric washings was positive only in the mother, in whom the Amanita phalloides spores were found. During the first 48 hours of poisoning the biochemical indexes of liver injury were observed in all persons. The whole family members were sent to centers where liver albumin dialysis could be performed: the mother was admitted to the Department of Nephrology and Dialysis Therapy in Olsztyn, the father and the first son were admitted to the Clinical Toxicology Department in Krak6w, and the second son was admitted to the Department of Internal Medicine and Acute Poisonings in Gdańsk. Three albumin dialysis procedures were performed in the case of mother with complete liver recovery. After the first liver albumin dialysis, the father of the family was disqualified from the following procedures because of severe coagulation disturbances (GI bleeding), and died the fourth day after mushroom ingestion. The first son fulfilled the King's College criteria and was accepted for high urgency liver transplantation. After two albumin dialysis procedures had been able and the patient was urgently sent to the Department of General and Transplantation Surgery in Szczecin, where liver transplantation was successfully performed. The second son was treated conservatively with improvement of general condition and biochemical indexes and no albumin dialysis procedure was necessary.


CONCLUSIONS
Liver albumin dialysis may be effective in severe Amanita phalloides poisoning to stabilize the condition of a patient until spontaneous liver regeneration occurs or as a bridge to LTx. In cases of a family poisoning, proper coordination and cooperation among toxicology departments and transplant centers is required.
Hydzik
Piotr
P
Klinika Toksykologii Collegium Medicum, Uniwersytetu Jagiellońskiego, Krakowie. piodzik@poczta.onet.pl
Gawlikowski
Tomasz
T
Ciszowski
Krzysztof
K
Kwella
Norbert
N
Sein Anand
Jacek
J
Wójcicki
Maciej
M
Lubikowski
Jerzy
J
Czupryńska
Małgorzata
M
D000328:Adult; D000545:Amanita; D017809:Fatal Outcome; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced / Q000601:surgery / Q000628:therapy*; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000601:surgery / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000150:complications* / Q000401:mortality / Q000601:surgery / Q000628:therapy; D011044:Poland; D006435:Renal Dialysis / Q000379:methods*; D012709:Serum Albumin / Q000378:metabolism*
D012709:Serum Albumin