Death Cap Mushroom

The death cap mushroom, Amanita phalloides, produces amatoxin which irreversibly binds to RNA polymerase II, preventing DNA transcription and subsequent protein synthesis, leading to cell death.

Epidemiology and Risk Factors

  • Most common toxic mushroom poisoning in Victoria

Pathophysiology

Aetiology

Clinical Features

Assessment

History:

Exam:

Investigations

Bedside:

Laboratory:

Imaging:

Other:

Diagnostic Approach and DDx

Management

Resuscitation:

Specific therapy:

  • Pharmacological
    • Multi-dose activated charcoal
    • Silibinin 5mg/kg for 1 hour, then 20mg/kg/day for 3 days
      Competitive inhibitor of amatoxin membrane transport, ↓ hepatocyte uptake. Alternatives include:
      • Rifampicin 600mg daily
      • Benzylpenicillin 600mg/kg/day
  • Procedural
  • Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

Prognosis

Key Studies

References

  1. Bahemia N. Something she ate?. Intensive. 2023.