Treatment of group <i>Amanita exitialis</i> poisoning_West China Medical Journal

Authors：

ZUO Ruiling ¹ , YANG Chun’ai ¹ , SHI Yan ² , YANG Shuo ³ , YANG Wentao ¹ , ZHU Junbo ¹ , XU Jun ⁴ ,  ZHENG Fenshuang ¹

1. Department of Emergency Medicine, the Affiliated Hospital of Yunnan University, the Second People’s Hospital of Yunnan Province, Kunming, Yunnan 650021, P. R. China;
2. Academy of Forensic Science, Shanghai 200063, P. R. China;
3. College of Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 210009, P. R. China;
4. Emergency Department of Peking Union Medical College Hospital, Beijing 100730, P. R. China;

Corresponding author：

ZHENG Fenshuang, Email: 503002938@qq.com

Keywords：

Amanita exitialis; group; poisoning; treatment

DOI：

10.7507/1002-0179.202310107

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Objective To explore the treatment methods for group Amanita exitialis poisoning, and summarize the treatment strategies for group Amanita exitialis poisoning. Methods A group of Amanita exitialis poisoning patients admitted to the Department of Emergency Medicine of the Affiliated Hospital of Yunnan University on July 31, 2023 were retrospectively included. We graded the patients’ condition and analyzed their clinical data, treatment methods, and blood purification selection modes. Results A total of 6 patients with Amanita exitialis poisoning were included, with an average age of 52 years. There were 2 patients with grade Ⅰ, 2 patients with grade Ⅱ, 1 patient with grade Ⅲ and 1 patient with grade Ⅳ. Grade Ⅰ patients choosed single one mode hemoperfusion (HP), grade Ⅱ patients choosed single multiple mode HP, grade Ⅲ patient choosed multiple mode HP combined with plasma exchange, and grade Ⅳ patient choosed multiple mode HP combined with plasma exchange, double plasma molecular adsorption system and continuous renal replacement therapy. After individualized comprehensive treatment, 5 patients were cured and discharged, and 1 patient died. Conclusions In the treatment of group Amanita exitialis poisoning, in addition to basic drug treatment, it is necessary to first consider factors such as the side effects of blood purification and the economic conditions of the patient. Then, according to the different disease grades of the patient, single or combined blood purification, single or multiple treatment modes can be choosed. Early selection of appropriate individualized blood purification modes can effectively buy time for poisoning patients.

Citation： ZUO Ruiling, YANG Chun’ai, SHI Yan, YANG Shuo, YANG Wentao, ZHU Junbo, XU Jun, ZHENG Fenshuang. Treatment of group Amanita exitialis poisoning. West China Medical Journal, 2023, 38(11): 1662-1665. doi: 10.7507/1002-0179.202310107 Copy

1.	中华医学会急诊医学分会中毒学组, 中国医师协会急诊医师分会, 中国毒理学会中毒与救治专业委员会. 中国含鹅膏毒肽蘑菇中毒临床诊断治疗专家共识. 中华危重症医学杂志(电子版), 2020, 13(1): 20-28.
2.	Patocka J, Wu R, Nepovimova E, et al. Chemistry and toxicology of major bioactive substances in inocybe mushrooms. Int J Mol Sci, 2021, 22(4): 2218.
3.	Huddam B, Alp A, Kırlı İ, et al. Medium cut-off membrane can be a new treatment tool in amanita phalloides poisoning. Wilderness Environ Med, 2021, 32(2): 192-197.
4.	Liu Y, Li S, Feng Y, et al. Serum metabolomic analyses reveal the potential metabolic biomarkers for prediction of amatoxin poisoning. Toxicon, 2023, 230: 107153.
5.	林丽颖, 陆远强. 急性鹅膏菌中毒的诊治进展. 中华危重症医学杂志(电子版), 2019, 12(5): 289-294.
6.	赖福平, 胡杰, 陆元兰, 等. ROS 激活 P53 调控线粒体凋亡途径在α-鹅膏毒肽中毒肝损害中作用的研究进展. 东南大学学报(医学版), 2022, 41(5): 734-739.
7.	刘润卿, 孙洁芳, 牛宇敏, 等. 鹅膏毒肽检测方法的研究进展. 分析测试学报, 2021, 40(4): 503-509.
8.	中国医师协会急诊医师分会, 中国急诊专科医联体, 中国医师协会急救复苏和灾难医学专业委员会, 等. 中国蘑菇中毒诊治临床专家共识. 中国急救医学, 2019, 39(8): 717-725.
9.	徐小民, 郑熠斌, 黄百芬, 等. 液相色谱-串联质谱法快速测定野生菌中 9 种蘑菇毒素. 中国食品卫生杂志, 2022, 34(2): 262-269.
10.	张秀尧, 蔡欣欣, 张晓艺, 等. 免疫亲和柱净化-超高效液相色谱-三重四极杆质谱法高灵敏测定尿液和血浆中 3 种鹅膏毒肽. 色谱, 2022, 40(5): 443-451.
11.	Zuker-Herman R, Tong R, Wong A. Intravenous rifampicin use in the management of amanita phalloides toxicity. Clin Toxicol (Phila), 2021, 59(9): 843-845.
12.	梁嘉祺, 章轶哲, 李海蛟, 等. 致命鹅膏的研究进展. 中国急救医学, 2023, 43(9): 689-695.
13.	易思亮, 赵志勇, 赵兰馨, 等. 混合阳离子固相萃取净化结合 UPLC-MS/MS 测定蘑菇及生物样本中鹅膏肽类毒素. 分析试验室, 2023, 42(7): 923-930.
14.	Gao J, Liu N, Zhang X, et al. Utilizing the DNA aptamer to determine lethal α-amanitin in mushroom samples and urine by magnetic bead-ELISA (MELISA). Molecules, 2022, 27(2): 538.
15.	Garcia J, Costa VM, Bovolini A, et al. An effective antidotal combination of polymyxin B and methylprednisolone for α-amanitin intoxication. Arch Toxicol, 2019, 93(5): 1449-1463.
16.	Gu X, Zhang L, Sun W, et al. Autophagy promotes α-amanitin-induced apoptosis of hepa1-6 liver cells. Chem Res Toxicol, 2022, 35(3): 392-401.
17.	Chen X, Shao B, Yu C, et al. The cyclopeptide -amatoxin induced hepatic injury via the mitochondrial apoptotic pathway associated with oxidative stress. Peptides, 2020, 129: 170314.
18.	Soond SM, Savvateeva LV, Makarov VA, et al. Making connections: p53 and the cathepsin proteases as co-regulators of cancer and apoptosis. Cancers (Basel), 2020, 12(11): 3476.
19.	Kim D, Lee MS, Sim H, et al. Characterization of complement C3 as a marker of alpha-amanitin toxicity by comparative secretome profiling. Toxicol Res, 2022, 39(2): 251-262.
20.	Wang B, Wan AH, Xu Y, et al. Identification of indocyanine green as a STT3B inhibitor against mushroom α-amanitin cytotoxicity. Nat Commun, 2023, 14(1): 2241.
21.	Garcia J, Costa VM, Carvalho AT, et al. A breakthrough on Amanita phalloides poisoning: an effective antidotal effect by polymyxin B. Arch Toxicol, 2015, 89(12): 2305-2323.
22.	蒲艳, 姚群梅, 钟加菊, 等. 致命鹅膏中毒三例报道. 中华劳动卫生职业病杂志, 2021, 39(10): 787-788.

1. 中华医学会急诊医学分会中毒学组, 中国医师协会急诊医师分会, 中国毒理学会中毒与救治专业委员会. 中国含鹅膏毒肽蘑菇中毒临床诊断治疗专家共识. 中华危重症医学杂志(电子版), 2020, 13(1): 20-28.
2. Patocka J, Wu R, Nepovimova E, et al. Chemistry and toxicology of major bioactive substances in inocybe mushrooms. Int J Mol Sci, 2021, 22(4): 2218.
3. Huddam B, Alp A, Kırlı İ, et al. Medium cut-off membrane can be a new treatment tool in amanita phalloides poisoning. Wilderness Environ Med, 2021, 32(2): 192-197.
4. Liu Y, Li S, Feng Y, et al. Serum metabolomic analyses reveal the potential metabolic biomarkers for prediction of amatoxin poisoning. Toxicon, 2023, 230: 107153.
5. 林丽颖, 陆远强. 急性鹅膏菌中毒的诊治进展. 中华危重症医学杂志(电子版), 2019, 12(5): 289-294.
6. 赖福平, 胡杰, 陆元兰, 等. ROS 激活 P53 调控线粒体凋亡途径在α-鹅膏毒肽中毒肝损害中作用的研究进展. 东南大学学报(医学版), 2022, 41(5): 734-739.
7. 刘润卿, 孙洁芳, 牛宇敏, 等. 鹅膏毒肽检测方法的研究进展. 分析测试学报, 2021, 40(4): 503-509.
8. 中国医师协会急诊医师分会, 中国急诊专科医联体, 中国医师协会急救复苏和灾难医学专业委员会, 等. 中国蘑菇中毒诊治临床专家共识. 中国急救医学, 2019, 39(8): 717-725.
9. 徐小民, 郑熠斌, 黄百芬, 等. 液相色谱-串联质谱法快速测定野生菌中 9 种蘑菇毒素. 中国食品卫生杂志, 2022, 34(2): 262-269.
10. 张秀尧, 蔡欣欣, 张晓艺, 等. 免疫亲和柱净化-超高效液相色谱-三重四极杆质谱法高灵敏测定尿液和血浆中 3 种鹅膏毒肽. 色谱, 2022, 40(5): 443-451.
11. Zuker-Herman R, Tong R, Wong A. Intravenous rifampicin use in the management of amanita phalloides toxicity. Clin Toxicol (Phila), 2021, 59(9): 843-845.
12. 梁嘉祺, 章轶哲, 李海蛟, 等. 致命鹅膏的研究进展. 中国急救医学, 2023, 43(9): 689-695.
13. 易思亮, 赵志勇, 赵兰馨, 等. 混合阳离子固相萃取净化结合 UPLC-MS/MS 测定蘑菇及生物样本中鹅膏肽类毒素. 分析试验室, 2023, 42(7): 923-930.
14. Gao J, Liu N, Zhang X, et al. Utilizing the DNA aptamer to determine lethal α-amanitin in mushroom samples and urine by magnetic bead-ELISA (MELISA). Molecules, 2022, 27(2): 538.
15. Garcia J, Costa VM, Bovolini A, et al. An effective antidotal combination of polymyxin B and methylprednisolone for α-amanitin intoxication. Arch Toxicol, 2019, 93(5): 1449-1463.
16. Gu X, Zhang L, Sun W, et al. Autophagy promotes α-amanitin-induced apoptosis of hepa1-6 liver cells. Chem Res Toxicol, 2022, 35(3): 392-401.
17. Chen X, Shao B, Yu C, et al. The cyclopeptide -amatoxin induced hepatic injury via the mitochondrial apoptotic pathway associated with oxidative stress. Peptides, 2020, 129: 170314.
18. Soond SM, Savvateeva LV, Makarov VA, et al. Making connections: p53 and the cathepsin proteases as co-regulators of cancer and apoptosis. Cancers (Basel), 2020, 12(11): 3476.
19. Kim D, Lee MS, Sim H, et al. Characterization of complement C3 as a marker of alpha-amanitin toxicity by comparative secretome profiling. Toxicol Res, 2022, 39(2): 251-262.
20. Wang B, Wan AH, Xu Y, et al. Identification of indocyanine green as a STT3B inhibitor against mushroom α-amanitin cytotoxicity. Nat Commun, 2023, 14(1): 2241.
21. Garcia J, Costa VM, Carvalho AT, et al. A breakthrough on Amanita phalloides poisoning: an effective antidotal effect by polymyxin B. Arch Toxicol, 2015, 89(12): 2305-2323.
22. 蒲艳, 姚群梅, 钟加菊, 等. 致命鹅膏中毒三例报道. 中华劳动卫生职业病杂志, 2021, 39(10): 787-788.

West China Medical Journal

Treatment of group Amanita exitialis poisoning

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