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A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to Humans?
Ismail Yilmaz1, Fatih Ermis2, Ilgaz Akata3
1Department of Pharmacology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey (Dr Yilmaz).
Abstract:
There are few data estimating the human lethal dose of amatoxins or of the toxin level present in ingested raw poisonous mushrooms. Here, we present a patient who intentionally ingested several wild collected mushrooms to assess whether they were poisonous. Nearly 1 day after ingestion, during which the patient had nausea and vomiting, he presented at the emergency department. His transaminase levels started to increase starting from hour 48 and peaking at hour 72 (alanine aminotransferase 2496 IU/L; aspartate aminotransferase 1777 IU/L). A toxin analysis was carried out on the mushrooms that the patient said he had ingested. With reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 21.3 mg amatoxin from nearly 50 g mushroom was calculated; it consisted of 11.9 mg alpha amanitin, 8.4 mg beta amanitin, and 1 mg gamma amanitin. In the urine sample taken on day 4, 2.7 ng/mL alpha amanitin and 1.25 ng/mL beta amanitin were found, and there was no gamma amanitin. Our findings suggest that the patient ingested approximately 0.32 mg/kg amatoxin, and fortunately recovered after serious hepatotoxicity developed.
Insights
This case study quantifies amatoxin levels in a mushroom poisoning survivor. The patient ingested ~21.3 mg of amatoxins, leading to severe liver damage but eventual recovery.
Area of Science:
- Toxicology
- Mycology
- Clinical Medicine
Background:
- Limited data exists on human lethal doses of amatoxins from poisonous mushrooms.
- Accurate quantification of toxins in ingested mushrooms is crucial for understanding poisoning severity.
Observation:
- A patient intentionally ingested wild mushrooms, later presenting with nausea, vomiting, and elevated transaminase levels.
- Hepatotoxicity peaked around 72 hours post-ingestion, with alanine aminotransferase reaching 2496 IU/L and aspartate aminotransferase 1777 IU/L.
Findings:
- Toxin analysis revealed approximately 21.3 mg of amatoxins (11.9 mg alpha amanitin, 8.4 mg beta amanitin, 1 mg gamma amanitin) from ~50g of mushrooms.
- Urine analysis detected 2.7 ng/mL alpha amanitin and 1.25 ng/mL beta amanitin on day 4.
- Estimated amatoxin intake was ~0.32 mg/kg.
Implications:
- This case provides valuable data on amatoxin toxicity and human lethal dose estimation.
- Highlights the importance of rapid toxin analysis and clinical monitoring in mushroom poisoning cases.
- Demonstrates that recovery is possible even after severe hepatotoxicity from amatoxin ingestion.