Usefulness of 13C-methacetin breath test in liver function testing in Amanita phalloides poisoning; breast feeding woman case.
BACKGROUND
Mortality from ingestion of the mushroom Amanita phalloides still remains as high as 8-10%. In critical patients, liver dialysis can bridge the patient to liver transplantation, which may be a lifesaving procedure. We report the use of 13C-methacetin breath test (13C-MBT) in monitoring hepatic function in a case of A. phalloides poisoning.


METHODS
A 33-year-old woman ate mushrooms that she had picked. After 8 h, she developed nausea and vomiting, abdominal cramps, and diarrhea, which lasted for another 24 h. On the third day, features of liver injury were seen. Pharmacologic therapy failed and she underwent liver dialysis on days 4 and 5. A 13C-MBT was used to evaluate hepatic functional reserve before the first and after the second dialysis. A liver transplantation on day 6 was successful.


CONCLUSIONS
The breath test results showed that at 40 min after substrate ingestion the mean 13C-MBT cumulative oxidation percentage was 10.5 +/- 3.8% in healthy controls, whereas in our patient this parameter decreased from 0.09% on the fourth day to 0.02% on the fifth day.


CONCLUSIONS
13C-MBT is a simple, non-invasive diagnostic tool which may be useful as a predictor of outcome and as a marker of the severity of liver damage.
Hydzik
Piotr
P
Department of Toxicology, Jagiellonian University Medical College, Krakow, Poland. piodzik@poczta.onet.pl
Bielañski
Władysław
W
Ponka
Małgorzata
M
Wójcicki
Maciej
M
Lubikowski
Jerzy
J
Pach
Janusz
J
Pawlik
Wiesłan
W
D000081:Acetamides; D000328:Adult; D000545:Amanita; D001942:Breast Feeding; D001944:Breath Tests / Q000379:methods; D002247:Carbon Isotopes; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008111:Liver Function Tests / Q000379:methods; D016031:Liver Transplantation; D013058:Mass Spectrometry; D009145:Mushroom Poisoning / Q000150:complications*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000081:Acetamides; D002247:Carbon Isotopes; C035495:methacetin