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Successful outcome of severe Amanita phalloides poisoning in children

Enke Grabhorn1, Dirk Nielsen, Georg Hillebrand

  • 1Department of Pediatric Hepatology and Liver Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany. a.richter@uke.de

Pediatric Transplantation
|June 1, 2013
PubMed

Insights

Amanita phalloides poisoning in children can cause liver failure. Early liver transplantation (LTx) or conservative treatment with silibinin and NAC can lead to survival, with careful monitoring crucial for LTx decisions.

Area of Science:

  • Toxicology
  • Pediatric Hepatology
  • Transplantation Medicine

Background:

  • Amanita phalloides (death cap mushroom) intoxication frequently causes acute liver failure (ALF) with high mortality, particularly in pediatric populations.
  • Optimal management strategies and criteria for emergency liver transplantation (LTx) in children with A. phalloides-induced ALF remain subjects of ongoing debate.

Purpose of the Study:

  • To retrospectively analyze clinical and laboratory data from pediatric patients with severe A. phalloides intoxication.
  • To identify factors that may guide decisions between emergency liver transplantation (LTx) and conservative management.
  • To compare outcomes with established adult treatment and transplantation criteria.

Main Methods:

  • Retrospective review of five pediatric cases of severe A. phalloides intoxication treated between 1995 and 2010.
  • Analysis of clinical presentations, laboratory values, treatment interventions (including silibinin, N-acetylcysteine (NAC), and intensive care), and outcomes.
  • Evaluation of indications for LTx, including progressive brain edema and cardiovascular failure.

Main Results:

  • All five pediatric patients survived the A. phalloides intoxication.
  • Two patients underwent emergency liver transplantation (LTx) due to progressive brain edema and cardiovascular failure.
  • Three patients recovered with conservative management, including intravenous silibinin, NAC, detoxification, and intensive care.
  • Late recovery of liver function was observed in some patients after day 4 post-ingestion.

Conclusions:

  • Pediatric patients with acute liver failure due to A. phalloides intoxication warrant early consideration for emergency LTx.
  • Close monitoring is essential to determine the necessity of definitive LTx.
  • Early detoxification measures, including active charcoal, silibinin, and NAC, appear to improve outcomes.
  • Conservative management can be successful, and late liver function recovery is possible.

Keywords:
acute liver failuremushroom poisoningoutcomepediatric liver transplantationprognostic scores

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