ABSTRACT
In this article, we aimed to presenta case developing liver and kidney damage after eating mushroom in the nature and emphasized the importance of hemoperfusion added into the treatment in an early phase. While tracking the 33-year-old male patient who was hospitalized due to nausea and vomiting 8-10 hours after he ate mushroom, it was observed that his liver transaminases rapidly increased (AST: 1137 U/L-2039 U/L, ALT: 1405 U/L-2341 U/L, INR: 4.46) and the patient with a thrombocyte number: 24.000/ mm3, was referred to an external center from the internal diseases department of our hospital for carbon filter hemoperfusion treatment. When encephalopathy, high level of liver transaminases and thrombocytopenia continued, the patient was taken into the intensive care unit on the second day of his treatment in the internal diseases department. A hemoperfusion treatment for 3 hours was added every day to the conventional treatment comprising high doses of penicillin-G, N-acetylcysteine, cimetidine, vitamin K and ascorbic acid. After the intensive care treatment, liver function tests of the patient receiving carbon filter hemoperfusion 6 times in total demonstrated recovery (AST: 79 U/L, ALT: 56 U/L, INR: 1.4, thrombocyte count: 109.000/mm3). There is no standard treatment strategy or antidote suggestion for cases diagnosed with mushroom poisoning. In the conventional treatment, gastric lavage, fluid-electrolyte support and active coal are given. Since the amatoxins in the plasma are disposed by kidneys, urine exit must be increased. Other treatment agents include silibinin, penicillin-G, vitamin C, corticosteroids, thioctic acid and N-acetylcysteine. Besides, plasmapheresis, hemoperfusion and hemodialysis are other invasive treatment options. In case of severe liver failure, the only treatment option is liver transplantation. Hemoperfusion is the process of transmitting the blood through a filter containing carbon or active coal. Agents connecting to protein and solving in fat can more easily be removed from the circulation. The beneficial effect of hemoperfusion occurs through not only cleaning alpha-amanitin from the plasma but also cleaning neurotoxic agents such as methionine, tryptophan, and phenylalanine.
Keywords: Mushroom poisoning, liver failure, extracorporeal treatment, hemoperfusion, carbon filter
