Substance abuse has been increasing steadily in the UK and some other countries. Recent evidence suggests more than 40% of young people have tried illicit drugs at some time. There are numerous medical consequences to recreational drug use, and a physician should always consider substance abuse in any unexplained illness. The renal complications of drug abuse are also becoming more frequent, and may encompass a spectrum of glomerular, interstitial and vascular diseases. Although some substances are directly nephrotoxic, a number of other mechanisms are also involved. These effects are often chronic and irreversible, but occasionally acute with possible recovery. The rapid growth of illicit drug use is clearly a major public health problem. We review the commonly used substances of abuse and their associations with renal disease. (+info)
Amanita virosa induced toxic hepatitis: report of three cases.
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We report here three cases of Amanita virosa induced toxic hepatitis. Two of the three cases recovered but the other died 10 days after mushroom ingestion. Since the mortality of Amanita mushroom induced toxic hepatitis is very high, prompt diagnosis and aggressive therapeutic measures should be initiated as soon as possible. Our cases showed that the initial serum aminotransferase levels might not predict the clinical outcome of the patient, but that the prothrombin time (PT) seemed to be a more useful prognostic marker. Close monitoring of aminotransferase levels and PT as well as appropriate therapy are recommended. All three cases showed signs of proteinuria and we were able to characterize mixed tubular and glomerular type proteinuria at 3 or 4 days after ingestion in two cases. Among the previously reported Korean cases of suspected Amanita induced toxic hepatitis, most species could not be identified except for four cases of Amanita virosa. No cases of Amanita phalloides induced toxic hepatitis have been identified in Korea so far. (+info)
5-Year analysis of mushroom exposures in California.
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OBJECTIVE: To evaluate outcomes following toxic mushroom ingestions. DESIGN: Retrospective data analysis. METHODS: We analyzed American Association of Poison Control Center data for California from 1993 through 1997. RESULTS: A total of 6,317 exposures occurred during the study period. Most (n = 6,229 [99.7%]) were acute exposures, and the rest (0.3%) were chronic; 87.6% (n = 5,536) were unintentional. Most (n = 4,235 [67.0%]) were in children younger than 6 years, and of these, only 6.0% experienced any clinical effects. The most common symptoms in patients aged 6 years and older were vomiting in 588 patients (28.2%), nausea in 307 patients (14.7%), diarrhea in 263 patients (12.6%), and abdominal pain in 221 patients (10.6%). No effects were seen in 3,131 (49.6% of all patients). Major effects were seen in only 17 patients (0.3%). Only 61 patients (1.0%) were admitted to a critical care unit. Death occurred in a 32-year-old adult who ate foraged mushrooms. Of all patients, 1,375 (21.8%) received no therapy or were observed only. CONCLUSIONS: Most mushroom exposures were acute and unintentional and occurred in children younger than 6 years. Major toxic reactions or death was uncommon. (+info)
Management of maternal Amanita phalloides poisoning during the first trimester of pregnancy: a case report and review of the literature.
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BACKGROUND: Amanita phalloides poisoning produces acute liver failure and often death. Maternal poisonings are rare, and medical decisions of abortion or liver transplantation in this critical situation frequently are based on laboratory data. We report here the case of a 22-year-old-woman in the 11th week of pregnancy, who ingested mushrooms. CASE REPORT: The patient's clinical symptoms (e.g., vomiting and diarrhea) and blood chemistry data (persistent increases of aspartate aminotransferase and alanine aminotransferase and severe decreases in prothrombin, factor V, factor II, factor VII, and factor X) indicated poisoning of medium severity. The management consisted of intravenous hydration, and administration of silymarine and N-acetylcysteine. No fetal damage was observed, and birth and development of the infant (now 2 years of age) proceeded without incident. CONCLUSION: Abortion is not necessarily indicated in maternal poisoning by A. phalloides, even in the first trimester of pregnancy. (+info)
Lethal ingestion of stored Amanita phalloides mushrooms.
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We report the first case of a lethal Amanita phalloides intoxication from stored mushrooms. After picking the mushrooms were kept in a freezer for 7-8 months. This case is in accordance with the well-known stability of the amatoxins and demonstrates the possibility of A. phalloides poisoning at any time of year. (+info)
A 66-year-old man with diabetes developed acute renal failure after ingestion of Amanita pseudoporphyria Hongo. Laboratory data showed acute nonoliguric renal failure. A renal biopsy showed acute tubular necrosis with glomerular minor abnormalities. He received hemodialysis treatment for 3 weeks and his renal function normalized 2 months after admission. We discuss the differences in acute renal failure caused by possible toxins of Amanita pseudoporphyria Hongo from that caused by other poisonous mushrooms. (+info)
Current applications of plasmapheresis in clinical toxicology.
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The clinical applications of plasmapheresis are rapidly increasing in number and scope. This trend is also observed in the application of plasmapheresis as a method of detoxification in clinical toxicology. Because of a lack of large controlled series, the rationale for using plasmapheresis must be confirmed in each type of intoxication by evidence of effective clearance, as well as by high plasma protein binding and a low volume of distribution of the toxic substance. Plasmapheresis is used mostly to treat phalloid mushroom intoxications. In this potentially fatal intoxication, for which there is no antidote, plasmapheresis is at least as effective as haemoperfusion in reducing mortality from as high as 30-50% with conventional therapy to <20%. In our series of 28 patients treated with plasmapheresis, mortality was 17.8%. In our experience, plasmaphe-resis is also very effective in the treatment of life-threatening intoxications with tricyclic (amitriptyline) and 4-cyclic (maprotyline) antidepressants. We confirmed a 63% reduction in the plasma level of amitriptyline in one patient after single plasmapheresis. Other drugs such as L-thyroxine, verapamil, diltiazem and carbamazepime are also removed effectively by plasmapheresis, as are theophylline and heavy metals (mercury and vanadate). Phosphoroorganic substances are not removed effectively. We measured the plasma concentrations of dimethoate in two patients with this intoxication and did not find clinically significant clearance with plasmapheresis. (+info)
Effects of picroliv, the active principle of Picrorhiza kurroa, on biochemical changes in rat liver poisoned by Amanita phalloides.
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The efficacy of Picroliv, a standardized iridoid glycoside fraction of Picrorhiza kurroa, was studied against the Amanita phalloides-induced biochemical changes in rat liver. A phalloides (50 mg.kg-1) caused significant increases in the activities of hepatic 5'-nucleotidase, gamma-glutamyl transpeptidase, acid ribonuclease, and succinate dehydrogenase, but a decrease in glucose-6-phosphatase. The level of cytochrome P-450 in microsomal fraction and content of glycogen in liver showed significant depletions. Picroliv (25 mg.kg-1.d-1 x 10 d) provided significant restorations of all the biochemical changes poisoned by A phalloides except cytochrome P-450 and glycogen. These results demonstrated the protective effect of Picroliv against A phalloides-induced hepatotoxicity in rats. (+info)