Successful outcome of severe Amanita phalloides poisoning in children

TY - JOUR

T1 - Successful outcome of severe Amanita phalloides poisoning in children

AU - Grabhorn, Enke

AU - Nielsen, Dirk

AU - Hillebrand, Georg

AU - Brinkert, Florian

AU - Herden, Uta

AU - Fischer, Lutz

AU - Ganschow, Rainer

N1 - © 2013 John Wiley & Sons A/S.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Amanita phalloides intoxication can lead to FHF with high mortality, especially in children. There is still ongoing discussion about the optimal treatment and decision criteria for emergency liver transplantation (LTx). Here, we summarize our experience with outcomes in five children. Five children with severe A. phalloides intoxication were treated at our tertiary center from 1995 to 2010 and studied retrospectively with respect to clinical and laboratory aspects that might help to decide between LTx or conservative therapy only. The findings are discussed with regard to recommended treatment and transplantation criteria for adults. All patients survived, of whom two of five received emergency LTx. Three patients survived with conservative treatment consisting of intravenous silibinin, NAC, detoxification measures, and intensive care. Indications for LTx in two children were progressive brain edema and cardiovascular failure. Children with FHF due to A. phalloides intoxication should be considered early for emergency LTx but should be monitored closely for the necessity of definite LTx. Early detoxification with active charcoal as well as silibinin and NAC seems to improve the outcome. Late recovery of liver function after day 4 post-ingestion is possible.

AB - Amanita phalloides intoxication can lead to FHF with high mortality, especially in children. There is still ongoing discussion about the optimal treatment and decision criteria for emergency liver transplantation (LTx). Here, we summarize our experience with outcomes in five children. Five children with severe A. phalloides intoxication were treated at our tertiary center from 1995 to 2010 and studied retrospectively with respect to clinical and laboratory aspects that might help to decide between LTx or conservative therapy only. The findings are discussed with regard to recommended treatment and transplantation criteria for adults. All patients survived, of whom two of five received emergency LTx. Three patients survived with conservative treatment consisting of intravenous silibinin, NAC, detoxification measures, and intensive care. Indications for LTx in two children were progressive brain edema and cardiovascular failure. Children with FHF due to A. phalloides intoxication should be considered early for emergency LTx but should be monitored closely for the necessity of definite LTx. Early detoxification with active charcoal as well as silibinin and NAC seems to improve the outcome. Late recovery of liver function after day 4 post-ingestion is possible.

KW - Acetylcysteine

KW - Amanita

KW - Antioxidants

KW - Child

KW - Child, Preschool

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Infant

KW - Intensive Care

KW - Liver Failure, Acute

KW - Liver Transplantation

KW - Male

KW - Mushroom Poisoning

KW - Prognosis

KW - Retrospective Studies

KW - Silymarin

KW - Treatment Outcome

U2 - 10.1111/petr.12108

DO - 10.1111/petr.12108

M3 - SCORING: Journal article

C2 - 23721499

VL - 17

SP - 550

EP - 555

JO - PEDIATR TRANSPLANT

JF - PEDIATR TRANSPLANT

SN - 1397-3142

IS - 6

ER -