From activated charcoal to selective plasma exchange: A retrospective
analysis of mushroom poisoning cases treated in the intensive care unit
Abstract
Background/aim: This study aims to evaluate presenting symptoms,
clinical and laboratory findings, and treatment modalities of adult
patients presenting with mushroom poisoning treated in the intensive
care unit (ICU) with special consideration of extracorporeal liver
support systems. Materials and methods: Records of patients with
mushroom poisoning treated in the ICU between January 2007 and December
2014 were analyzed retrospectively. Results: Sixteen adult patients were
treated in the ICU for mushroom poisoning during the designated study
period. Presentation to the hospital was most common during October of
each year. Average time from ingestion of mushrooms to first symptoms
was 17.81 hours, and to ICU admission was 2.38 days. The most common
symptoms were nausea, vomiting and diarrhea. The most common laboratory
finding was elevation of liver transaminases. In cases with elevated
liver transaminases, penicillin G, silibinin and N-acetyl cysteine were
used. Extracorporeal support systems were used in 9 cases. Two cases
underwent emergency liver transplantation. Conclusion: Liver
transplantation is the most definitive and effective treatment in
indicated cases of mushroom poisoning. Extracorporeal support systems
should be considered in the early period both as a treatment modality on
their own or to save time until the definitive treatment is possible.
The question of which extracorporeal detoxification technique to use is
difficult to answer and controlled clinical trials which compare their
efficacy are needed.