A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to Humans?


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Yilmaz I., Ermis F., AKATA I., KAYA E.

WILDERNESS & ENVIRONMENTAL MEDICINE, vol.26, no.4, pp.491-496, 2015 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 26 Issue: 4
  • Publication Date: 2015
  • Doi Number: 10.1016/j.wem.2015.08.002
  • Journal Name: WILDERNESS & ENVIRONMENTAL MEDICINE
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.491-496
  • Keywords: Amanita phalloides, amanitin, sublethal toxicity, high-performance liquid chromatography, PHALLOTOXIN CONCENTRATION, RETROSPECTIVE ANALYSIS, MUSHROOM
  • Ankara University Affiliated: Yes

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.