title: A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to Humans?
abstract: There are few data estimating the human lethal dose of amatoxins or of the toxin level present in ingested raw poisonous mushrooms. Here, we present a patient who intentionally ingested several wild collected mushrooms to assess whether they were poisonous. Nearly 1 day after ingestion, during which the patient had nausea and vomiting, he presented at the emergency department. His transaminase levels started to increase starting from hour 48 and peaking at hour 72 (alanine aminotransferase 2496 IU/L; aspartate aminotransferase 1777 IU/L). A toxin analysis was carried out on the mushrooms that the patient said he had ingested. With reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 21.3 mg amatoxin from nearly 50 g mushroom was calculated; it consisted of 11.9 mg alpha amanitin, 8.4 mg beta amanitin, and 1 mg gamma amanitin. In the urine sample taken on day 4, 2.7 ng/mL alpha amanitin and 1.25 ng/mL beta amanitin were found, and there was no gamma amanitin. Our findings suggest that the patient ingested approximately 0.32 mg/kg amatoxin, and fortunately recovered after serious hepatotoxicity developed.
authors.affiliation: Department of Pharmacology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey (Dr Yilmaz). Electronic address: driyilmaz@yahoo.com.
authors.forename: Ismail
authors.initials: I
authors.lastname: Yilmaz
authors.affiliation: Department of Gastroenterology, Duzce University School of Medicine, Duzce, Turkey (Dr Ermis).
authors.forename: Fatih
authors.initials: F
authors.lastname: Ermis
authors.affiliation: Department of Biology, Faculty of Science, Ankara University, Ankara, Turkey (Dr Akata).
authors.forename: Ilgaz
authors.initials: I
authors.lastname: Akata
authors.affiliation: Department of Pharmacology, Duzce University School of Medicine, Duzce, Turkey (Dr Kaya).
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Kaya
mesh_terms: D000545:Amanita / Q000737:chemistry*; D000546:Amanitins / Q000008:administration & dosage* / Q000032:analysis / Q000506:poisoning; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning / Q000209:etiology* / Q000628:therapy*
chemical_list: D000546:Amanitins; C049197:beta-amanitin; C018207:amatoxin
keywords: Amanita phalloides; amanitin; high-performance liquid chromatography; sublethal toxicity