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

Video：

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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.	中華醫學會急診醫學分會中毒學組, 中國醫師協會急診醫師分會, 中國毒理學會中毒與救治專業委員會. 中國含鵝膏毒肽蘑菇中毒臨床診斷治療專家共識. 中華危重癥醫學雜志(電子版), 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, K?rl? ?, 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.	林麗穎, 陸遠強. 急性鵝膏菌中毒的診治進展. 中華危重癥醫學雜志(電子版), 2019, 12(5): 289-294.
6.	賴福平, 胡杰, 陸元蘭, 等. ROS 激活 P53 調控線粒體凋亡途徑在α-鵝膏毒肽中毒肝損害中作用的研究進展. 東南大學學報(醫學版), 2022, 41(5): 734-739.
7.	劉潤卿, 孫潔芳, 牛宇敏, 等. 鵝膏毒肽檢測方法的研究進展. 分析測試學報, 2021, 40(4): 503-509.
8.	中國醫師協會急診醫師分會, 中國急診專科醫聯體, 中國醫師協會急救復蘇和災難醫學專業委員會, 等. 中國蘑菇中毒診治臨床專家共識. 中國急救醫學, 2019, 39(8): 717-725.
9.	徐小民, 鄭熠斌, 黃百芬, 等. 液相色譜-串聯質譜法快速測定野生菌中 9 種蘑菇毒素. 中國食品衛生雜志, 2022, 34(2): 262-269.
10.	張秀堯, 蔡欣欣, 張曉藝, 等. 免疫親和柱凈化-超高效液相色譜-三重四極桿質譜法高靈敏測定尿液和血漿中 3 種鵝膏毒肽. 色譜, 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, 章軼哲, 李海蛟, 等. 致命鵝膏的研究進展. 中國急救醫學, 2023, 43(9): 689-695.
13.	易思亮, 趙志勇, 趙蘭馨, 等. 混合陽離子固相萃取凈化結合 UPLC-MS/MS 測定蘑菇及生物樣本中鵝膏肽類毒素. 分析試驗室, 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.	蒲艷, 姚群梅, 鐘加菊, 等. 致命鵝膏中毒三例報道. 中華勞動衛生職業病雜志, 2021, 39(10): 787-788.

1. 中華醫學會急診醫學分會中毒學組, 中國醫師協會急診醫師分會, 中國毒理學會中毒與救治專業委員會. 中國含鵝膏毒肽蘑菇中毒臨床診斷治療專家共識. 中華危重癥醫學雜志(電子版), 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, K?rl? ?, 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. 林麗穎, 陸遠強. 急性鵝膏菌中毒的診治進展. 中華危重癥醫學雜志(電子版), 2019, 12(5): 289-294.
6. 賴福平, 胡杰, 陸元蘭, 等. ROS 激活 P53 調控線粒體凋亡途徑在α-鵝膏毒肽中毒肝損害中作用的研究進展. 東南大學學報(醫學版), 2022, 41(5): 734-739.
7. 劉潤卿, 孫潔芳, 牛宇敏, 等. 鵝膏毒肽檢測方法的研究進展. 分析測試學報, 2021, 40(4): 503-509.
8. 中國醫師協會急診醫師分會, 中國急診專科醫聯體, 中國醫師協會急救復蘇和災難醫學專業委員會, 等. 中國蘑菇中毒診治臨床專家共識. 中國急救醫學, 2019, 39(8): 717-725.
9. 徐小民, 鄭熠斌, 黃百芬, 等. 液相色譜-串聯質譜法快速測定野生菌中 9 種蘑菇毒素. 中國食品衛生雜志, 2022, 34(2): 262-269.
10. 張秀堯, 蔡欣欣, 張曉藝, 等. 免疫親和柱凈化-超高效液相色譜-三重四極桿質譜法高靈敏測定尿液和血漿中 3 種鵝膏毒肽. 色譜, 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, 章軼哲, 李海蛟, 等. 致命鵝膏的研究進展. 中國急救醫學, 2023, 43(9): 689-695.
13. 易思亮, 趙志勇, 趙蘭馨, 等. 混合陽離子固相萃取凈化結合 UPLC-MS/MS 測定蘑菇及生物樣本中鵝膏肽類毒素. 分析試驗室, 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. 蒲艷, 姚群梅, 鐘加菊, 等. 致命鵝膏中毒三例報道. 中華勞動衛生職業病雜志, 2021, 39(10): 787-788.

West China Medical Journal

Treatment of group Amanita exitialis poisoning

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