What’s better for amatoxin poisoning: silibinin or leprechaun luck?

Amanita phalloides 2 out of 5 stars Survival Following Investigational Treatment of Amanita Mushroom Poisoning: Thistle or Shamrock? Gores KM et al. Chest 2014 Oct 1 [Epub ahead of print] Abstract Amatoxins are potent RNA inhibitors, shutting down protein synthesis and producing hepatonecrosis and, occasionally, renal injury. There is not generally accepted treatment for amatoxin-induced hepatotoxicity aside from supportive care, early multi dose activated charcoal, and liver transplant if indicated. There are, however, a number of unproven therapies that have been used and advocated in the past. This case report, from the University of Iowa College of Medicine, describes a 71-year-old man who presented with vomiting, diarrhea and weakness 3 days after ingesting mushrooms foraged in northwestern Iowa. Laboratory examination revealed elevated AST (2313 IU/L) and ALT (2730 IU/L), but only slightly elevated total bilirubin and an INR of 1.3 (normal up to 1.2). There was evidence of renal insufficiency with a creatinine  of 2.7 mg/dL (normal, 0.51 – 1.2 mg/dL). Treatment was started with IV N-acetylcysteine and penicillin. The next day he became encephalopathic and was started on the experimental drug silibinin. Silibinin is derived from the milk thistle plant (Silybum marianum). It is has not been FDA approved, but was available as part of a phase 2/3 Open Multicenter Clinical Trial. The drug apparently inhibits entry of amatoxin into hepatocytes. It is generally belie...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical amanita phalloides amatoxin milk thistle mushroom poisoning silibinin Source Type: news