1/11. Fatal mushroom poisoning caused by amanita virosa in thailand.Consumption of toxic mushrooms belonging to the genus amanita frequently leads to severe gastrointestinal distress followed by acute hepatic failure with a fatal outcome. In thailand, valuable information as to the locally prevalent poisonous species, the preferred habitat and the management of suspected victims of intoxication is basically non-existent. We report here 5 cases of fatal poisoning with amanita virosa having occurred in a family residing in the northeast of thailand who as countless others had enjoyed mushroom gathering as a pasttime. Within 4 to 6 days after ingestion of the mushrooms, all had succumbed to acute hepatic failure with subsequent hepatoencephalopathy. Treatment modalities exist in the form of penicillin and silibinin, or thioctic acid administration followed by plasmapheresis. In cases taking a lethal course apparent from the results of liver biochemistry, liver transplantation is clearly indicated. In order to prevent mushroom poisoning altogether, educating the general population to that end certainly presents the method of choice.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/11. Successful treatment of a child with fulminant liver failure and coma caused by amanita phalloides intoxication with albumin dialysis without liver transplantation.FLF is a life-threatening disease. Hepatic coma exerts dramatic impact on patient survival. At present, LTx is the treatment modality of choice that provides significant improvement in outcome of most patients with FLF. Multiple attempts have been made to reduce mortality and improve the patient's condition. One of the new options is AD - mars. We present the case of a 11-yr-old boy with FLF and hepatic coma who avoided the scheduled LTx because of rapid neurological and biochemical improvement immediately after three mars sessions.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
3/11. Renal transplants from non-heart beating paracetamol overdose donors.INTRODUCTION: Non-heart beating donors (NHBD) are widely encouraged to avert the critical shortage in the kidney donor pool. Ischaemic injury at the time of cardiac arrest in the NHBD is more pronounced and therefore the kidneys resulting are considered marginal. This review describes our experience with four kidneys from two controlled NHBDs who were exposed to paracetamol intoxication and subsequently were treated with mannitol prior to organ donation. MATERIALS AND METHOD: Two patients with fulminant liver failure following paracetamol overdose were referred as 'withdrawal of treatment' NHBD. As the two patients had developed hepatic encephalopathy they were treated with mannitol to reduce intra-cerebral oedema. The two donors were oligoanuric for at least 24 h prior to cardiac arrest. Following cardiac arrest, in situ perfusion was carried out and the kidneys were removed. One pair of kidneys were machine perfused while the second pair of kidneys were cold stored prior to transplantation. RESULTS: Pre-transplant assessment of NHBD kidneys resulted in three of four kidneys being transplanted. The NHBD kidneys exhibited a period of delayed graft function (DGF). The early transplant biopsies showed evidence of diffuse cytoplasmic vacuolation. These histological features disappeared with time and the renal function improved until the time of discharge. DISCUSSION: Non-heart beating donor kidneys are considered marginal and the effect of mannitol and paracetamol drug intoxication will induce reversible sub-lethal injury. A period of dialysis is inevitable in clearing the reactive intermediates of mannitol and paracetamol. The kidneys behaved as traditional controlled NHBD at time of discharge.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
4/11. Molecular adsorbent recirculating system--mars as a bridge to liver transplantation in amanita phalloides intoxication.A case of a 46-year-old female intoxicated with amanita phalloides was presented. Since constant deterioration of her liver function she was put on the waiting list for urgent liver transplantation. To improve her clinical condition two sessions of Molecular Adsorbent Recirculating System were provided with transient good results. About 72 hours after the mushroom ingestion the patient had undergone liver transplantation. Conclusions: Despite good clinical condition the patients severely poisoned with amanita phalloides should be placed on a waiting list for liver transplantation as early as possible. The Molecular Adsorbent Recirculating System should be introduced as soon as possible after amanita phalloides intoxication. Albumin dialysis may be considered as a bridge for the liver transplantation in patients intoxicated with amanita phalloides.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
5/11. amanita poisoning: treatment and the role of liver transplantation.Fatal mushroom poisoning has long been recognized as a major health problem in western europe and more recently in the united states. The majority of deaths are attributable to the genus amanita. amanita phalloides (death cap) has been found with increasing frequency across the united states and presents a significant health hazard in this country to those who pick and consume wild mushrooms. This article discusses the pharmacologic basis and clinical manifestations of amanita intoxication. It outlines the rationale of various treatment modalities and, from these, summarizes a protocol that the authors believe will be useful to the clinician. In addition, two patients are presented who underwent successful orthotopic liver transplantation for fulminant hepatic failure secondary to amanita poisoning. The role of liver transplantation both acutely and as treatment for chronic active hepatitis secondary to severe intoxication is discussed.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
6/11. Acute ammonia intoxication 37 years after ureterosigmoidostomy.Ureterosigmoidostomy causes hyperammonemia, which can, especially in the presence of hepatic disease, lead to metabolic encephalopathy and coma. In the case reported here, acute hyperammonemic encephalopathy developed 37 years after the operation, and responded promptly to oral neomycin therapy, with clinical and electroencephalographic resolution. magnetic resonance imaging of the brain, not previously reported in this disorder, showed symmetric lesions of the white matter.- - - - - - - - - - ranking = 4keywords = intoxication (Clic here for more details about this article) |
7/11. Phencyclidine-induced malignant hyperthermia causing submassive liver necrosis.This report describes three male patients arrested for aggressive and combative behavior, characteristic of phencyclidine intoxication, in whom severe hyperthermia, respiratory failure, and coma developed. Two days after the malignant hyperthermic event, serum transaminase levels rose acutely to extremely high levels with concomitant elevations in bilirubin levels and a fall in prothrombin activity. Liver biopsy specimens in two patients showed marked perivenular necrosis and collapse. No specific treatment was directed at the phencyclidine intoxication. Two of the three patients survived. Submassive liver necrosis caused by malignant hyperthermia is an unusual complication of phencyclidine abuse.- - - - - - - - - - ranking = 2keywords = intoxication (Clic here for more details about this article) |
8/11. amanita phalloides intoxications in a family of russian immigrants. case reports and review of the literature with a focus on orthotopic liver transplantation.alpha-amanitin, the main toxin of the death cap fungus (amanita phalloides) is one of the most dangerous natural poison. This toxin damages eukaryotic cells by inhibiting their transcription. Lesions are seen in cells with rapid protein synthesis, particular in liver and renal cells, even at low toxin concentrations. Without adequate intensive therapy, the outcome of alpha-amanitin poisoning is very poor. This article reports various courses of amanitin intoxication in a family. In 3/4 patients, severe hepatic failure developed as assessed by a decrease of all coagulation factors, mainly Quick's test and factor v (< 10%-15%). Despite vigorous replacement of coagulation factors, in 1 of the patients orthotopic liver transplantation had to be performed on day 4, whereas in all other patients liver function improved spontaneously. All patients survived their intoxication. Both the pharmacological basis and clinical manifestations of amanita intoxication are discussed. On this basis a treatment scheme is presented which the authors believe may be useful to clinicians.- - - - - - - - - - ranking = 7keywords = intoxication (Clic here for more details about this article) |
9/11. flumazenil as a diagnostic tool in the differential diagnosis of coma in a critically ill patient.The purpose of this report is to describe the use of flumazenil as a diagnostic aid in the differential diagnosis of coma in a patient with an inadvertent overdose of benzodiazepines. We report a patient with suspected septic encephalopathy whose level of consciousness markedly improved following flumazenil administration. Subsequent analysis revealed the presence of benzodiazepines and their metabolites in the blood and urine although the patient had not received benzodiazepines for over two weeks. The critically ill patient with multiorgan failure may have considerable derangement of benzodiazepine metabolism; therefore, if an obtunded patient's level of consciousness improves following flumazenil administration, benzodiazepine intoxication must be considered.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
10/11. amanita phalloides, a potentially lethal mushroom: its clinical presentation and therapeutic options.mushroom poisoning with amanita phalloides, a rare phenomenon in everyday clinical practice in the netherlands, must be recognized early in view of its potential morbidity and mortality. In this article 2 cases of amanita intoxication are presented and the pharmacological basis and clinical manifestations discussed. Furthermore, the rationale of various treatment modalities, including the role of liver transplantation, is outlined.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
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