Treatment of toxic fungal poisoning

The article was consulted professionally by Specialist I Do Van Manh – Emergency Resuscitation Department – Share99 Ha Long International Hospital.

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Knowing how to distinguish which fungi can be used to make food and poisonous fungi is the most effective measure to prevent poisoning caused by poisonous fungi. In addition, medical staff also need to know the diagnosis, initial treatment and treatment of early poisoning of fungi to avoid serious disease progress and lead to death.

1. Classification of poisonous fungi

Fungi containing toxins will cause poisoning of the human body or animals when inge. For the classification of poisonous fungi there will be two following classifications:

1.1 Classification of toxic fungi by toxins

According to this division, poisonous mushrooms will have 8 groups:

  • Amatoxin (Cyclopolypeptide): Amanita verna, A. virosa, A. phalloides, Galerina autumnalis, Lepiota brunneoincarnata,…
  • Gyromitrin (Monomethylhydrazin): Gyromitra esculenta, G. infula,…
  • Orellanin: Cortinarius orellanus, C. speciosissimus, C. Splendens,…
  • Muscarin: Inocybe fastigiata, Clitocybe dealbata,…
  • Ibotenic Acid and Muscimol: Amanita muscaria, A. pantherina,…
  • Coprinus atramentarius, Coprinus,…
  • Psilocybin and Psilocin are found in four species: Psilocybe, Panaeolus, Conocybe and Gymnopilus.
  • Chlorophyllum molybdites, Russula foetens, Omphalotus nidiformis… causes gastrointestinal disorders:

Blue Slab White Umbrella Mushroom – Chlorophyllum Molybdites

Blue Slab White Umbrella Mushroom – Chlorophyllum Molybdites

1.2 Classification of toxic mushrooms over time of toxins

  • Slow-acting poison: The time for symptoms of poisoning to appear after eating mushrooms containing poison is usually 6-40 hours (an average of 12 hours). Since the first symptoms of poisoning appear after eating for long periods of time, this type is often fatal. The fungus contains Amanita verna, Amanita virosa, Amanita phalloides,… will belong to the group of slow-moving toxins and have a mortality rate of about 50% even higher
  • Fast-acting poison: In this case the first symptoms will appear within 6 hours after eating the fungus. Fungi containing Inocybe fastigiata, Chlorophyllum molybdites… will belong to the fast-growing poison group. Patients with poisoning of this group of fungi, if treated with poisoning in a timely manner and applying basic resuscitation emergency measures, the rate of passing and recovering well is relatively high.

2. Signs of poisoning of the fungus

After eating mushrooms containing toxins, symptoms of fungal poisoning will take place in the following stages:

  • Potential stage (from the moment of eating the fungus to the on the first symptomatic appearance): Usually lasts from 6-24 hours (an average of 12 hours), and after eating the fungus the patient does not feel any abnormal signs
  • Stage of gastrointestinal disorders: Usually appears between 10-12 hours after eating mushrooms. At this stage, the person will have symptoms such as nausea, vomiting, abdominal pain, diarrhea (whole water stools, opaque white like cholera)
  • The false stage of recovery: After about 1-3 days of the appearance of gastrointestinal disorders, these symptoms seem to cease. However, this stage is considered a period when the condition deteriorates because this is the time for the process of toxins to damage liver cells
  • Stage of liver and kidney failure: Usually takes place on the 4th or 5th day after eating mushrooms. The clinical manifestation of the patient during this period will be jaundice to varying degrees; gastrointestinal, cerebral, urinary, under-skin bleeding; edema; little urination or anuria; coma and lead to death due to liver failure, kidney failure, cerebral edema complications.

Signs of poisoning of the fungus

Some signs of toxic fungal poisoning

3. Treatment and treatment of toxic fungal poisoning

3.1 Handling at home and in medical facilities

It is necessary to quickly take measures to eliminate toxins outside the body such as:

  • Try to get the sick person to vomit out mushroom food that has just eaten within the first 1 hour
  • In case patients show strange symptoms after 6 hours of eating mushrooms, activated charcoal can be given at a dosage: 1g/ kg, time from 2 – 3 hours / time
  • Medical staff perform gastric rinsing of the patient and the time after eating within 1-2 hours.

3.2 Treatment of toxic fungal poisoning in hospitals

  • Examination of blood biomedification indicators: AST (GOT), ALT (GPT), bilirubin, protrombin content, PT, glucose, ure, creatinine, electrolyte, pH
  • Perform routine blood tests
  • Perform a urine test with 11 basic indicators.

urine

Urine tested to help assess body poisoning

Toxic fungi containing amatoxin are treated with the following hospital regimen:

  • Give activated charcoal at a frequency of 3-4 hours, for the accompanying sorbitol. To exclude reabsorption of amatoxin according to the gastrointestinal tract it is necessary to use activated carbon and sorbitol for at least 3 days
  • Suck out for 48 hours by placing gastric sonde
  • Take penicillin G in doses:
    • Adults 250,000 units/ kg intramuscularly or intravenously twice daily within 5 days
    • Children are prescribed a dosage of 300,000 – 500,000 units depending on the weight 2 times / day within 5 days.
  • Oral Legalon (Silymarin, Silibinin, Silybin) high doses: Adults take 600 – 1200 mg twice daily, children 10 – 15 mg/kg of body weight twice daily. When liver enzymes return to normal values, discontinue use
  • Silibinin can be used instead of Legalon at a dosage of 20 – 80mg/kg/day divided into 2 intravenous infusions in 2 hours
  • Cimetidin: Adults take a dose of 400 mg 3 times daily for 5 days. Children take a dose of 10 mg/ kg of body weight 3 times daily within 5 days
  • Take Vitamin C at a dosage of 1g, 2 times / day, intravenously until the bio-bio chemical indicators are close to normal
  • Conduct an infusion of 0.9% sodium chloride or Ringer lactate with the amount of infusion according to the degree of poisoning, the condition of the kidneys responds to dies.

Infusion

Infusion for fungal poisoning
  • Furosemid (Lasix): 20mg intravenous tube, repeat if necessary to reach 150 – 200ml of urine/ hour
  • Antiglysis by glucose infusion (10% – 1000ml/ 24h)
  • Rehabilitation of the liver using intravenous N. acetylcysteine 70mg/kg initial dose then 35mg/kg of body weight every 4 hours. Discontinuation when liver function has recovered
  • Monitor and correct electrolycical disorders and regulate blood acidosis with sodium bicarbonate
  • Hemolysis or hemorrhagic manifestations occur:
    • Inject vitamin K in corn at a dose of 10 – 20 mg or intravenously 10 – 40 mg/ 24 hours, depending on the degree of coaculation disorders
    • Infusion of fresh plasma when protrombin < 40% khi có biểu hiện xuất huyết
  • Treatment when there is cerebral edema:
    • Mechanical breathing
    • Manitol use: When threatening brain drops, intravenous infusion of 400ml (20%) in 1 hour
    • Cerebral manifestations – the liver is in insularly placed to protect the airways
  • Treatment when renal failure uses dies in patients with mild poisoning or conducts hemodialysis, if dies no longer work
  • Anti-infection: broad-spectrum antibiotics (3rd generation cefalosporins), high doses
  • Plasma or hepatic replacement.

Artificial liver

Artificial liver images used instead

Specialist I Do Van Manh has more than 10 years of experience in the field of Active Resuscitation – Anti-Toxicity. He served as deputy head of the Active Resuscitation Department of Quang Ninh General Health Hub before working at Share99 Ha Long International Health Hub.

Customers can directly go to Share99 Health System nationwide for medical examination and treatment or contact to make an appointment online HERE.

SEE MORE:

  • Notes when first aiding people with poisoning
  • Identify signs and first aid when food poisoning
  • Signs of abdominal pain caused by food poisoning

SEE MORE:

  • Poisonous mushrooms you need to know
  • What would the body be like if it was poisoned with mercury?
  • Paracetamol poisoning in children

About: John Smith

b1ffdb54307529964874ff53a5c5de33?s=90&r=gI am the author of Share99.net. I had been working in Vinmec International General Hospital for over 10 years. I dedicate my passion on every post in this site.

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