title: Amatoxin poisoning: a 15-year retrospective analysis and follow-up evaluation of 105 patients.
abstract: BACKGROUND
  Fatalities due to mushroom poisonings are increasing worldwide, with more than 90% of deaths resulting from ingestion of amatoxin-containing species.
  
  
  METHODS
  A retrospective evaluation of the history and clinical outcome of each patient treated from 1988 to 2002 in the Toxicological Unit of Careggi General Hospital (University of Florence, Italy) for amatoxin poisoning. Data included the biological parameters monitored, the treatment protocols used (intensive fluid and supportive therapy, restitution of the altered coagulation factors, multiple-dose activated charcoal, mannitol, dexamethasone, glutathione, and penicillin G), and outpatient follow-up evaluations.
  
  
  RESULTS
  The clinical data of 111 patients were evaluated; their biological parameters were monitored every 12-24 hours until discharge. Two patients died; both were admitted to the hospital more than 60 hours after mushroom ingestion. Of all the laboratory parameters evaluated, the evolution of hepatic transaminases and prothrombin activity over four days were the most predictive indicators of recovery or death. Our follow-up evaluation of 105 patients demonstrated that our survivors recovered completely.
  
  
  CONCLUSIONS
  Our experience indicates that the protocol used in our Toxicologicy Unit is effective for amatoxin poisoning, and that all patients treated within 36 hours after mushroom ingestion were cured without sequelae.
authors.affiliation: Department of Preclinical and Clinical Pharmacology, Azienda Ospedaliero-Universitaria Careggi, Toxicology Unit, University of Florence, Florence, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Giannini
authors.forename: Alfredo
authors.initials: A
authors.lastname: Vannacci
authors.forename: Andrea
authors.initials: A
authors.lastname: Missanelli
authors.forename: Rosanna
authors.initials: R
authors.lastname: Mastroianni
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Mannaioni
authors.forename: Flavio
authors.initials: F
authors.lastname: Moroni
authors.forename: Emanuela
authors.initials: E
authors.lastname: Masini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000546:Amanitins / Q000506:poisoning* / Q000652:urine; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000097:blood / Q000453:epidemiology / Q000628:therapy* / Q000652:urine; D011379:Prognosis; D011517:Prothrombin Time; D013997:Time Factors
chemical_list: D000546:Amanitins; C018207:amatoxin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase