9. Treatment of Amatoxin Poisoning-20 year retrospective analysis

724
Table 4. Continued
Treatments
Detoxication
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Urin.
FD ECP HD–HP/PL LT Surv. References
Oral
C/GA
Date/Country T/E Cases Mushroom Drugs
1991–1998 Bulgaria 25/25 A.ph, a.sp Steroid, Vit.E 25/0 25 (HD–HP)/(PL) 0 15 [179]
1977–1992 Slovak 58/58 A.ph Thioc.a 0/0 44 17–58/12 0 38 [180]
Republic
1979–1985 Sweden 19/41 A.ph, A.vi, a.sp Thioc.a 19/0 0 19–19/0 0 19 [149]
1982–1984 Italy 2/6; child. A.ph, a.sp, amat Thioc.a 2/0 0 2–0/2 0 0 [181]
1982–1986 Spain 59/85; (child.) 27 A.ph, 24 a.sp, 7 Thioc.a 18/15 28 0–4/2PL 3 EXE 0 56 [43,50,182–
L.bi, 1 L.f
184]
1985 Italy 53/53; 6 child. A.ph, amat Thioc.a 53/53 (FD) (HD)–0/(PL) 0 47 [185]
1986–1988 Spain 2/4 A.ph, amat Thioc.a 2/0 2 0–0/0 0 0 [182,183]
1987 Italy 2/2 A.ph, amat Thioc.a 0/0 0 0–0/2 0 2 [186]
1988 Spain 1/1 A.ph Thioc.a 0/0 0 0–1/0 0 1 [187]
1989 Spain 10/10 3 L.bi, 7 L.hel, Thioc.a 10/0 0 0–10/0 0 8 [188]
amat
1990 Spain 1/1 A.ph Thioc.a 0/0 0 1–0/0 0 1 [189]
b
1982 Belgium 4/4; 1 child A.ph, amat Thioc.a,
0/0
0–0/0 0 3 [190]
Vit.C
1990–1994 France 11/29 5 A.ph, 6 a.sp Vit.C 4/0 0 1–0/0 0 10 [138]
1992 France 3/4 L.hel Vit.C 1/0 0 0–0/0 0 3 [169]
T/E Cases ¼ treated/exposed individuals; Oral ¼ oral detoxication using C ¼ activated charcoal and GA ¼ gastroduodenal aspiration; Urin. ¼ urinary detoxication by FD ¼ forced diuresis;
ECP ¼ extra-corporeal detoxication including HD ¼ hemodialysis, HP ¼ hemoperfusion, and PL ¼ plasmapheresis (or EXE ¼ exsanguino transfusion); LT ¼ liver transplant;
Surv. ¼ survivors; amat ¼ amatoxins in biological fluids; undefined cases are reported in brackets; ATB ¼ antibiotic agent; ATS ¼ antiseptic agent (nifuroxazide); Cimetid ¼ cimetidine;
NAC ¼ N-acetylcysteine; Thioc.a ¼ thioctic acid; Vit.C ¼ vitamin C; Vit.E ¼ vitamin E; a.sp ¼ amatoxin-containing species; A.ph ¼ Amanita phalloides; A.vi ¼ A. virosa; L.bi ¼ Lepiota
brunneoincarnata; L.cas ¼ L. castanea; L.f. ¼ L. fulvella; L. hel ¼ L. helveola.
a
Neomycin instead of benzylpenicillin.
b Spironolactone.
Enjalbert et al.