Intensive hemodialysis and hemoperfusion treatment of Amanita mushroom poisoning.

Over a period of fifteen years, 41 patients including 23 males and 18 females with Amanita mushroom poisoning were treated at the University Hospital of Lund, Sweden. The intensity of poisoning was graded according to serum transaminase elevations and prothrombin time reductions. Severity was mild in 16 patients (Group A), moderate in 14 (Group B) and severe in 11 (Group C). Members of Group C reported shorter latency periods before the onset of symptoms, (10 +/- 1 hours, P < 0.05) and longer delays in treatment, (34 +/- 4 hours), than did the other patients. Intensive treatment was begun before the results of urine amatoxin assay were reported. Treatment consisted of: fluid and electrolyte replacement, oral activated charcoal and lactulose, i.v. penicillin, combined hemodialysis and hemoperfusion in two 8 hour sessions, some received i.v. thioctic acid, other i.v. silibinin, all received a special diet. This combination of treatment modalities was used to accelerate the elimination of amatoxin from the patients' bodies. The longest period of hospitalization, 13 +/- 2 days, was required by the patients of Group C (p < 0.01). All patients improved and were discharged from the hospital asymptomatic. No sequelae were later reported for the majority of those moderately and severely poisoned. We have concluded that intensive combined treatment applied in these cases is effective in relieving patients with both moderate and severe amanitin poisoning.

Intensified dialysis treatment of ethylene glycol intoxication.

During a period of 10 years 18 men were treated for severe ethylene glycol (EG) intoxication. All patients received supportive measures and ethanol infusion. Hemodialysis (HD) was applied in 11 patients (Group I) whereas 7 patients, who exhibited more advanced toxicity symptoms, received peritoneal dialysis (PD) simultaneously with HD (Group II). Patients in Group II showed more advanced acidosis on admission than in Group I (Base excess -27.1 mmol/l versus -16.8 mmol/l, p < 0.0075). The results of treatment in these two groups of patients were compared. All patients in Group I survived and one patient in Group II died. The patients in Group II were discharged with higher serum creatinine and follow up time to improve renal function was longer than in Group I (252 versus 149 mumol/l, p < 0.015 and 23 versus 7.9 weeks, p < 0.05 respectively). No correlations were found between serum EG and grade of acidosis on admission or serum EG and subsequent increase of serum creatinine but acidosis on admission was highly correlated to the rise of serum creatinine after the 72 hours of observation time (p < 0.0001). It is concluded, that combined HD and PD treatment was beneficial in the presented patients as it corrected acidosis earlier and could eliminate EG and its toxic metabolites faster, improving prognosis.