Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 12 December 2017

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Factors associated with severe hepatitis due to mushroom poisoning

The most recent issue of the Clinical Gastroenterology & Hepatology examines features of patients with severe hepatitis due to mushroom poisoning and factors associated with outcome.

News image

Acute liver failure after ingestion of toxic mushrooms is a significant medical problem. 

Most exposures to toxic mushrooms produce no symptoms or only mild gastroenteritis, but some lead to severe hepatic necrosis and fulminant hepatic failure requiring liver transplantation. 

Dr Maurizio Bonacini and colleagues from California, USA assessed mortality from mushroom poisoning, and identified variables associated with survival and liver transplantation.

The researchers collected information from 27 patients admitted to the emergency department within 24 hours of ingesting wild mushrooms. 

The team developed severe liver injury, and were treated with activated charcoal and N-acetylcysteine at a tertiary medical center in San Francisco, California from 1997 through 2014. 

26% to 50% of patients could have avoided transfer to a transplant center
Clinical Gastroenterology & Hepatology
Viral hepatitis, autoimmune liver disease, acetaminophen, salicylate toxicity, and chronic liver diseases were ruled out for all patients. 

The researchers analyzed patient demographics, time since ingestion, presenting symptoms, laboratory values, and therapies administered. 

A good outcome was defined as survival without need for liver transplant. 

The team defined a poor outcome as death or liver transplant. 

The researchers observed that liver injury was attributed to ingestion of Amanita phalloides in 24 patients and Amanita ocreata in 3 patients. 

The team found that 24 of the patients ingested mushrooms with meals, and 3 patients for hallucinogenic purpose. 

At 24–48 hours after ingestion, all patients had serum levels of alanine aminotransferase ranging from 554 to 4546 IU/L. 

The researchers observed that acute renal impairment developed in 5 patients. 

There were 23 patients that survived without liver transplantation, and 4 patients had poor outcomes. 

Of the 23 patients with peak levels of total bilirubin of 2 mg/dL or more during hospitalization, only 4 had a poor outcome. 

Peak serum level of aspartate aminotransferase less than 4000 IU/L, peak international normalized ratio less than 2, and a value of serum factor V greater than 30% identified patients with good outcomes with 100% positive predictive value.

The team observed that if these peak values were used as a cutoff, 26% to 50% of patients could have avoided transfer to a transplant center.

Dr Bonacini's team comments, "In an analysis of 27 patients with hepatocellular damage due to mushroom (Amanita) poisoning and peak levels of total bilirubin greater than 2 mg/dL, the probability of liver transplantation or death is 17%, fulfilling Hy’s law."

"Patients with peak levels of aspartate aminotransferase less than 4000 IU/L can be monitored in a local hospital, whereas patients with higher levels should be transferred to liver transplant centers."

"Women and older patients were more likely to have a poor outcome than men and younger patients."

Clin Gastroenterol Hepatol 2017: 15(5): 776–779
04 May 2017

Go to top of page Email this page Email this page to a colleague

 12 December 2017 
Risk factors in undiagnosed cirrhosis
 12 December 2017 
Monitored anesthesia care for outpatient GI endoscopy
 12 December 2017 
High-risk colorectal cancer patients
 06 December 2017 
Preventing hepatic encephalopathy-related readmissions
 06 December 2017 
Reflux-induced chronic cough 
 06 December 2017 
Systemic inflammatory response syndrome in acute-on-chronic liver failure
 05 December 2017 
Childhood obesity into adulthood
 05 December 2017 
CT imaging for acute diverticulitis
 05 December 2017 
Thiopurines and colorectal cancer in IBD
 04 December 2017 
Neoadjuvant chemoradiation for locally advanced rectal cancer
 04 December 2017 
Physical activity and Barrett’s esophagus
 04 December 2017 
Alcohol abstinence and alcoholic hepatitis
 01 December 2017 
Therapeutic drug monitoring in IBD
 01 December 2017 
Insulin therapy and liver cancer among diabetics
 01 December 2017 
Family burden of pediatric Crohn's in the USA
 30 November 2017 
Anastomotic leak after repeat intestinal resection in Crohn’s
 30 November 2017 
Oral capsule– vs colonoscopy-delivered fecal microbiota transplant
 30 November 2017 
Sessile serrated polyps and H. pylori in the USA
 29 November 2017 
Medical cannabinoid legalization policy and vomiting
 29 November 2017 
Predicting mortality after colectomy for C. diff
 29 November 2017 
Obesity and cancer risk
 28 November 2017 
Celiac disease screening in adult first-degree relatives
 28 November 2017 
Electronic health record alert in primary care in Hep C
 28 November 2017 
Surgical treatment delays and colon cancer survival
 27 November 2017 
Challenges in measuring the affordability of US health care
 27 November 2017 
Questionnaire fore chronic constipation
 27 November 2017 
Early readmission in IBD patients
 24 November 2017 
Osteoporotic fractures in Barrett's esophagus
 24 November 2017 
Center ERCP volume and procedure success
 24 November 2017 
Adipokines and IBD
 23 November 2017 
Incidence of biopsy-verified celiac disease
 23 November 2017 
Pharmacological management of GERD
 23 November 2017 
Distance travelling for rectal cancer outcomes
 22 November 2017 
Challenges of US-trained gastroenterologists when abroad
 22 November 2017 
Surgical treatment delays influence survival in colon cancer
 22 November 2017 
Golimumab in Crohn's disease
 21 November 2017 
Preoperative optimization in IBD patients
 21 November 2017 
Cholangiopathy in critically ill patients
 21 November 2017 
Prepregnancy obesity and maternal mortality
 20 November 2017 
Socioeconomic characteristics in diverticular disease
 20 November 2017 
Barriers to hepatitis C treatment
 20 November 2017 
Endoscopic indices of disease activity for Crohn’s
 17 November 2017 
Predicting microscopic colitis
 17 November 2017 
Food elimination diets for treatment of adults with eosinophilic esophagitis
 17 November 2017 
PPI use and cognitive function in women
 16 November 2017 
NAFLD-hepatocellular carcinoma and survival after orthotopic liver transplant
 16 November 2017 
Prepregnancy obesity and severe maternal morbidity
 16 November 2017 
Celiac disease screening in adult first-degree relatives
 15 November 2017 
Breastfeeding and the risk of IBD
 15 November 2017 
Predicting recurrence after curative rectal cancer surgery
 15 November 2017 
Medication nonadherence and health care costs
 14 November 2017 
Eosinophilic gastroenteritis and colitis
 14 November 2017 
HBV/HCV coinfection and cirrhosis
 14 November 2017 
Sexual dysfunction after rectal cancer surgery
 13 November 2017 
Genetic polymorphisms, fatty acids and ulcerative colitis
 13 November 2017 
Flares after immunomodulator withdrawal in Crohn's
 13 November 2017 
GI bleeding in patients taking non–vitamin K antagonist oral anticoagulants
 10 November 2017 
Thiopurines vs TNF and lymphoma risk in IBD
 10 November 2017 
Drug monitoring of anti-tumour necrosis factor therapy in IBD
 10 November 2017 
Treatment decisions for older patients with colorectal cancer

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2017 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us