title: Amatoxin poisoning: case reports and review of current therapies.
abstract: BACKGROUND
  Diagnosis and management of Amanita mushroom poisoning is a challenging problem for physicians across the United States. With 5902 mushroom exposures and two resultant deaths directly linked to Amanita ingestion in 2009, it is difficult for physicians to determine which patients are at risk for lethal toxicity. Identification of amatoxin poisoning can prove to be difficult due to delay in onset of symptoms and difficulty with identification of mushrooms. Consequently, it is difficult for the Emergency Physician to determine proper disposition. Further, treatment options are controversial.
  
  
  OBJECTIVE
  To review current data to help health care providers effectively identify and treat potentially deadly Amanita mushroom ingestions.
  
  
  METHODS
  We present two cases of Amanita mushroom ingestion in the northeastern United States treated with N-acetylcysteine, high-dose penicillin, cimetidine, and silibinin, a semi-purified fraction of milk thistle-derived silymarin, as part of their treatment regimen. The mushroom species was identified by a consultant as Amanita Ocreata.
  
  
  CONCLUSIONS
  We present the successful treatment of 2 patients who ingested what we believe to be an Amanita species never before identified in the northeastern United States.
authors.affiliation: University of Massachusetts Medical School, Worcester Massachusetts 01655, USA.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Ward
authors.forename: Kishan
authors.initials: K
authors.lastname: Kapadia
authors.forename: Eric
authors.initials: E
authors.lastname: Brush
authors.forename: Steven D
authors.initials: SD
authors.lastname: Salhanick
mesh_terms: D000368:Aged; D000545:Amanita; D000546:Amanitins / Q000506:poisoning*; D000975:Antioxidants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000546:Amanitins; D000975:Antioxidants; C018207:amatoxin