Fly agaric poisoning

In the family of fly agaric or amanitaceae (amanitaceae) there are many different fungi, and not all of them are poisonous, there are also edible ones. However, the word fly agaric immediately recalls only one of them. This beautiful mushroom is known “in person” even by small children from pictures in children's books. Everyone knows that it is poisonous. A bright red glossy hat with white convex dots and a pleated collar on the leg of a mature mushroom - this appearance can not be confused with anything. Therefore, in the post-Soviet space, accidental poisoning with fly agaric, namely classic, red, is very rare. In European countries, such cases in the mushroom season (late summer-early autumn) are more common, as mushrooms are used that are vaguely reminiscent of red fly agaric at some stages of their development, for example, Caesarean mushroom, an extremely tasty edible representative of fly agaric, growing in southern Europe.

Other, more unpretentious fly agaric with white, greenish-brown and gray-brown hats fall into the basket for mushroom pickers a little more often. They can be confused with edible mushrooms - champignons, russula, edible and tasty gray-pink or thick fly agaric. Mortally dangerous representatives of the fly agaric family are fly agaric - smelly and spring, and also their closest relative is the pale grebe, which is essentially a green fly agaric.

The description and photographs of poisonous mushrooms are widely replicated, however, it is impossible to exclude an accident associated with the consumption of fly agaric. Our article will tell about how poisoning manifests itself with different types of fly agaric, and how to help the victim. Although, of course, the best preventive measure is the utmost attention to the contents of the basket.

Amanita muscaria (fly agaric) is a spectacular and well-recognized ectomycorrhizal fungus that is natural and common in coniferous and deciduous forests of the temperate zone of the northern hemisphere. In recent decades, it has been introduced into the southern hemisphere by forestry and therefore has become a cosmopolitan species (Reid and Eicker 1991). Amanita is widely known as psychoactive due to the hallucinogenic effect of some of its compounds. 

Epidemiology

Poisoning is an important global public health problem. According to the Centers for Disease Control and Prevention (CDC) report, more than 41,000 people died in 2008 from unintentional poisoning, while the World Health Organization (WHO) has recorded 0.346 million deaths since 2004 worldwide. [1]

In recent decades, statistics practically did not record fatal poisoning with red and panther fly agarics, since the concentration of toxic substances in case of accidental ingestion of fly agaric in food was insufficient for this. Mushroom poisoning is quite common, especially in summer and autumn, but fly agaric (Amanita muscaria) and Amanita pantherina are a fairly rare cause of these poisonings. Most often, fly agaric is the cause of deliberate poisoning. 95% of deaths from ingestion of mushrooms worldwide occur from fungi containing amatoxin, in particular fly agaric. [2]

Mortality due to fly agaric poisoning is about 30%, which was higher than in most other studies. [3]Recent data from the American Association of Poison Control Centers annual report showed a low mortality rate of less than 10%. [4]

But such representatives of the fly agaric family as pale, white and spring grebes, otherwise - fly agaric: green, smelly and spring are in the lead in the ranking of the most dangerous mushrooms. They are very poisonous, a third of the hat is enough to make the mushroom dish completely inedible. More than half of the cases of poisoning by these fungi end fatally. In addition, the poisonous mushroom spoils even with the touch of the edible neighbors in the basket.

Causes of the fly agaric poisoning

To be poisoned with fly agaric, it is necessary to eat it and, most often, not one fungus, but several - dry, boiled, fried, raw, or drink a strong mushroom broth or infusion. A lethal dose for an adult is approximately 15 caps of red mushroom. So, if one small fly agaric of this species comes across in a large pan with edible fried mushrooms, then there may not be a noticeable deterioration in the condition, especially in adults.

The story goes that the inhabitants of the Kamchatka Peninsula used red fly agaric “for fun” during feasts. S.P. Wrote about this. Krasheninnikov, Russian researcher of Siberia and Kamchatka (XVIII century). They drank an infusion of fly agaric or swallowed dried mushroom caps. The result was a dose-dependent effect similar to different degrees of intoxication. The use of no more than four mushrooms caused vivacity, fun, lightness, about a dozen - a condition similar to delirium, accompanied by hallucinations and delirium. Thus, only adult men “had fun”. There are other reports that fly agaric was made vodka, the excessive use of which often ended in psychomotor agitation with human victims or fatal poisoning. Amanita used shamans of different nations to achieve a state of trance.

These historical facts are widely known, the hallucinogenic properties of poisonous mushrooms are used today to achieve a narcotic effect. Intentional use of them in such a quality can cause toxicoman poisoning. In addition, it is possible that today a fly agaric is added to counterfeit low-grade vodka for a fortress, and it is quite possible to poison it.

The collection and use of mushrooms and other plants containing psychoactive substances is becoming increasingly popular among young people experimenting with drugs. [5]

Alternative healers use drugs from fly agaric, which can also be poisoned if the admission rules are not followed.

Risk factors for accidental poisoning with fly agaric are seasonal and are associated with the collection of mushrooms. In the old days in rural life they were used for their intended purpose - they stained flies, placing dishes with mushroom broth or fried mushrooms as bait in the summer. These poisonous flies sometimes poisoned small children. Currently, this use of fly agaric is no longer relevant.

A raw fungus can be eaten by a small child, left unattended, due to children's curiosity and a desire to try everything “by the teeth”, or an inexperienced mushroomer picks up very young fly agarics, mistaking them for good mushrooms, and feed them a family. Although such mistakes are most often made in European countries, for example, in France or in Italy, where they collect caesarean mushroom that looks like a red fly agaric.

Rather, small mushrooms of a panther fly agaric or more mature specimens with washed out dots after heavy rain can accidentally fall into a basket of an inattentive mushroom picker. The mushroom has hats of all shades of brown and is easier to confuse with those that can be eaten. And it looks like edible fly agarics - gray-pink and thick. True, unlike them, the mushroom flesh produces a not too strong unpleasant odor and a bitter taste.

Grebe-like fly agaric mushrooms - smelly, spring and green are confused with russula and champignon mushrooms.

Pathogenesis

The pathogenesis of poisoning is reduced to the action of several toxic substances and is described as a syndrome that makes up a certain clinical picture. Amanita species such as red and panther cause myco-atropine syndrome. The composition of poisons in these types of fly agaric is somewhat different, but the total toxic effect of the syndrome caused by them is defined as anticholinergic. [6]

The main toxins of these two fungi are ibotenic acid (pantherin, agarin), muscimol, muscazone and muscaridine. Other biologically active substances are stizolobic and stizolobic acids and aminodicarboxyethylthiopropanoic acids. All of these compounds are responsible for the diverse picture of intoxication. [7]

The most famous toxic substance is muscarine, it was isolated at the end of the 19th century and was considered the main culprit of poisoning when using fly agaric, attributing to it the ability to cause all symptoms of poisoning, including mental disorders. However, a more detailed study showed that muscarine is far from the main poisonous substance in the fly agaric. In its pure form, it causes a pronounced cardiotoxic effect - it dilates blood vessels, reducing blood pressure and decreasing the minute volume of blood, which, when large doses are received, can lead to cardiac arrest in the diastole phase. In addition, muscarine causes a clinical picture characteristic of poisoning - weakness and sweating, nausea, vomiting, hypersalivation, and also affects the bronchi and lungs, in large doses causing choking. But muscarin and its derivatives in fly agaric are not numerous at all, its effects are not leading.

The psychotropic substances contained in the mushrooms in solid quantities turned out to be other components - ibotenic acid and its metabolic products: muscimol and muscazone. They perfectly overcome the blood-brain barrier and have a psychomimetic effect. Ibotenic acid is akin to glutamic (excitatory amino acid), muscimol is similar in structure to a mediator of inhibition of γ-aminobutyric acid, due to which these substances block the receptors of two important neurotransmitters, blocking the ion channels and disrupting the metabolic processes in the brain. Depending on the dose taken, the patient develops dissociative disorders, hypnotic states, acute psychoses. In addition, unchanged ibotenic acid is a neurotoxin and causes brain cell death. A. Muscaria can affect the activity of neurons in the central regions of the brain. [8], [9]

Muskasone anticholinergic is contained in fly agaric in small quantities, it is produced in mushrooms only under the influence of insolation. There are also traces of bufotenin and other psychoactive toxins (tryptophan, tryptamine, muscaridine, acids - stizolobic, stizolobin, methylenetetrahydrocarbolinecarboxylic, tricholomic), but their effect is not so significant due to the low content.

The panther fly agaric contains, in addition to the substances described above, tropane alkaloids - hyoscyamine and scopolamine. Its psychotropic effect is much more pronounced than that of red. Panther fly agarics have also been used and are being used as a narcotic potion.

With the use of grebe-like fly agaric mushrooms (green, smelly, spring), the phalloidin syndrome develops. The toxic substances responsible for the pathogenesis of poisoning with these fungi are amatoxins, which block the cellular synthesis of protein molecules, and phallotoxins, which destroy the membranes of the liver cells and inhibit mitochondrial oxidative phosphorylation. The effect of amatoxins is most harmful for organs whose cells intensively produce protein: intestines, liver, kidneys, pancreas, lymphoid tissue. Enterocytes are the first to occur with poison, but symptoms of acute gastroenteritis, indicating poisoning, develop no earlier than six hours after eating mushrooms.

Phallotoxins that cause inflammation of the mucous membrane of the gastrointestinal tract, getting into the intestinal lumen are partially destroyed by digestive enzymes and cooking, they do not have such a powerful toxic effect as amatoxins. These poisons are not subject to the destructive effect of high temperatures - they are resistant to drying and cooking, insoluble in water, and it is they who are responsible for damage to the tissues of the digestive and excretory organs with the subsequent development of encephalopathy.

The damaging combined effect of amatoxins and fallotoxins causes necrotic changes in the intestinal mucosa, it loses its barrier function, which leads to disruption of the intestinal biocenosis in favor of the propagation of pathogenic flora. As a result, an additional source of bacterial toxemia is created in the portal circulation pool and contributes to further damage to the liver cells.

Smelly fly agaric - a mushroom of white or grayish-white color. It is also called the white grebe. It produces an unpleasant odor similar to bleach. It is this feature that saves most inexperienced mushroom pickers from eating it. Edible mushrooms with which you can confuse a stinky fly agaric, for example, champignons, do not have such a smell. A deadly fungus containing amatoxins and fallotoxins. Their complex effect causes fatal poisoning when eating white (spring) fly agaric, as well as green, better known as pale grebe.

Symptoms of poisoning do not appear immediately, a latent period lasts from six hours to two days. Poisons begin to act immediately. In the absence of signs of poisoning, the process of death of cells of organs actively producing protein occurs. When its first symptoms appear (vomiting, abdominal pain), you need to get help immediately. Then there is real hope for a favorable outcome.

Symptoms of the fly agaric poisoning

The first signs are precisely the symptoms characteristic of poisoning, weakness, heavy sweat, nausea with severe salivation, vomiting, diarrhea, rumbling in the abdomen is constantly heard, and to everyone around. In case of poisoning with red or panther fly agarics, they appear quite quickly, as a rule, half an hour or an hour after eating mushrooms. The maximum period before poisoning appears is six hours. The neurotoxic effect is manifested by dizziness, miosis, double vision, flies in front of the eyes and other visual impairments. In severe cases, inappropriate behavior, impaired consciousness, delusional-hallucinatory disorder are observed, respiratory function and heart function are disturbed. Cerebral edema, coma and death can occur, mainly from acute heart failure.

Non-fatal poisoning with red fly agaric is comparable to a state of severe intoxication. The patient is excited, he has bouts of unbridled fun, sometimes unexpectedly replaced by vicious antics. From the side, the patient’s behavior is not clear to others, his perception of reality is disturbed, he is under the influence of hallucinations - auditory, visual, olfactory, but can still respond to events and answer questions. In the last stage, the patient is completely in the illusory world, delirious, does not give an account of his actions, after which he falls into a deep narcotic sleep. Waking up, he does not remember anything and feels overwhelmed. [10]

Poisoning with panther fly agaric is more severe, since an atropine-like effect is added. The symptom complex is called "panther syndrome." On average, an hour or two after consumption, symptoms of intestinal upset appear, dry mouth, shortness of breath, and increased heart rate. The pupils become dilated, that is, the symptoms of atropine poisoning prevail. At the same time, and sometimes earlier, psychotic symptoms appear, which is manifested by a state of euphoria and hallucinatory syndrome. Patients are usually very agitated, there may be cramps. In general, with poisoning with panther fly agaric, the symptoms of a disorder of the central nervous system are more pronounced. Excitation with the hallucinatory-delusional component gradually turns into a state of inhibition and apathy up to an unconscious state. [11]

In alternative medicine, red and panther fly agarics are used. Poisoning with tincture of fly agaric can be when used inside as a medicine. When used externally for compresses and rubbing with radiculitis and rheumatism, poisoning usually does not reach the point if the integrity of the skin is not broken. But in the presence of damage to the skin surface, poisoning cannot be ruled out. Symptoms of poisoning with tincture of fly agaric are identical to those that cause the use of raw or dried mushrooms - digestive disorders and brain phenomena of varying severity.

Mild intoxication usually goes away within a few hours, in severe cases, a coma develops and the victim may die. [12]

Poisoning with a smelly fly agaric (white grebe) and other amanitin-containing mushrooms is initially asymptomatic. The first latent period lasts at least six hours, and in some cases drags on for up to two days. Destructive work of poisons is already in the absence of symptoms. It was noticed that during this period the victims were unduly excitable and anxious, however, in the absence of other manifestations, this was not enough to consult a doctor.

Therefore, if suddenly, against the background of unexpected weakness, vomiting begins, and very frequent, several times a minute, first with food, then with a cloudy liquid with bile fragments (while the patient used mushrooms for the last two to three days), urgent need to seek help. So begins the second stage - acute gastroenteritis. Diarrhea and severe stitching pains in the abdomen can be delayed and begin in a few hours. In severe cases, cholera-like symptoms develop, blood in watery bowel movements, countless urges to defecate, sudden dehydration, accompanied by dry mouth and thirst. The patient's condition may be aggravated by heartburn, muscle pain, impaired heart function, oliguria, fainting. The patient's skin is pale, hands and feet are cold. The stage of acute gastrointestinal inflammation lasts from three to six days. Sometimes there is no abdominal pain. Already at this stage, neurological symptoms may appear - myoclonus, tonic-clonic convulsions (more often in childhood); violation of sensitivity, coordination of movements, coordination, confusion, hallucinations, delirium.

Then a period of false improvement begins, the manifestations of gastroenteritis subside, but weakness, hypotension persist, appetite decreases, there may be muscle cramps and residual symptoms of dehydration. The third stage of the imaginary well-being of many victims is misleading, because the patient feels relieved and thinks that the danger has passed. At this stage, liver and kidney damage is formed, which manifests itself in the next, fourth stage of poisoning.

A sharp increase in the liver is palpated, petechiae, gum bleeding, and symptoms of encephalopathy appear. In the beginning, the whites of the eyes turn yellow, later with an increase in the level of bilirubin in the blood, yellowness of the skin spreads. The skin is dry and itches, the smell from the mouth appears, weakness builds up, the appetite disappears, the patient suffers from insomnia, pain is felt on palpation on the right. Neurological symptoms join: an excited state and lethargy, inadequate reactions, hallucinations. Blood coagulation is impaired, hemorrhagic syndrome intensifies - spontaneous bruises appear, gums bleed, women may have uterine bleeding, patients of any gender have blood in vomit, feces and urine. Body temperature can reach pyrethic values, and can be greatly reduced. Dysfunction of the liver and kidneys progresses, respiratory failure, depression of consciousness develops. The patient may die as a result of irreversible damage to the intestines, liver and kidneys, thrombohemorrhagic syndrome, adrenal insufficiency. These vital organs fail on the eighth or tenth day.

When conducting timely symptomatic therapy to maintain organ functions using a detoxification technique, the fifth stage occurs - recovery.

Poisoning with a white fly agaric (spring), as well as with its green counterpart (pale grebe), proceeds according to the same scenario. The duration of the recovery phase is determined by the severity of intoxication and often requires a long time.

Complications and consequences

Poisoning with fly agaric, belonging to any species, can lead to death of the victim. Acute respiratory failure is the most dangerous symptom observed in cases of poisoning.

In addition, survivors may develop irreversible damage to internal organs, which will cause chronic diseases that require constant medical monitoring, drug therapy and certain restrictions on diet and physical activity, which reduces the quality of life. Often, liver transplantation is required. [13]

The minimum lethal dose for amatoxin is 0.1 mg / kg body weight (5–15 mg of amatoxin is contained in approximately 15–20 dried fly agaric hats, which is sufficient to kill a healthy adult). After 24–48 hours of administration, patients develop gastrointestinal symptoms, jaundice, renal failure, and coma. [14],  [15] Total mortality rate is 5-40%. A much smaller dose is enough for children, the elderly and chronic patients, too. The content of toxic substances in fly agarics varies depending on the place of collection of mushrooms, their age and method of preparation. Accordingly, the severity and consequences of poisoning depend on this. Aggravating factors are the resistance of fly agaric toxins to drying and cooking.

Grebe-like fly agaric mushrooms (smelly, spring, green) are very poisonous. Their lethal dose is 1 g per kilogram of the victim’s body weight (about a third of the cap), even taking the mushroom in your hands or eating the edible mushrooms that were lying next to you in the basket can poison you.

Diagnostics of the fly agaric poisoning

Amanita poisoning is manifested, first of all, by a gastrointestinal upset. According to other symptoms, it can be assumed which species caused the poisoning. Of great importance is the time during which developed severe symptoms. The faster (up to two hours after consumption) the symptoms of gastroenteritis appeared, the less dangerous the poisoning. It is good if you can examine the remnants of food or the remaining raw mushrooms, although usually not all the collection consists of fly agaric and grebes. In addition, the advice of an experienced mycologist is required.

Analyzes to determine the toxins of fly agaric in biological fluids of a victim at the level of a regular hospital are practically impossible. But sometimes the diagnosis of poisoning Amanita pantherina or Amanita muscaria is established by mycological examination of the contents of the stomach after washing. [16] Therefore, they are guided by the clinical signs of poisoning, conduct general blood and urine tests, and also monitor blood sugar levels, make liver tests, which show an increase in transaminase activity (as a result of massive cytolysis of enterocytes and hepatocytes), a tendency to increase protein deficiency, increase bilirubin level and lengthening of prothrombin time.

Instrumental diagnostics can give certain ideas about the state of internal organs. This is mainly an ultrasound examination of the liver, Doppler ultrasound and radioisotope hepatography.

Regarding poisoning with fly agaric, they are treated in the presence of symptoms of acute gastroenteritis. 

Differential diagnosis

Differential diagnosis is carried out with other food poisoning; intoxications with acetaminophen, organophosphorus compounds, heavy metals, drugs that reduce blood glucose; acute appendicitis; intestinal infections, in particular cholera; non-infectious gastroenteritis; the manifestation of viral hepatitis, etc.

Treatment of the fly agaric poisoning

In most cases, a person suffering from mushroom poisoning is given symptomatic and supportive therapy. Properly provided first aid is of great importance. What to do with fly agaric poisoning? As with any ingress of toxic substances into the body, first of all, you need to help get rid of them as quickly as possible. That is, rinse the stomach, repeatedly inducing vomiting, give enterosorbent (activated charcoal is almost always in the medicine cabinet), laxative and call an ambulance. Before the arrival of the brigade, the victim is laid in bed, sheltered warmly, given a plentiful drink. 

If there is a suspicion of mushroom poisoning, the patient is hospitalized. Given that the clinical picture of poisoning by different fungi is similar, the general approach to helping is initially the same in all cases. In the future, the dynamics of the course of poisoning allows us to determine the optimal treatment methods.

In the toxicogenic stage of poisoning, first of all, efforts are concentrated on the elimination of toxic substances from all distribution media. In the first hours, the patient is given tube gastric lavage, laxatives are prescribed and, in addition, enteric detoxification of the body is performed. Activated carbon is used as an enterosorbent at the rate of 0.5-1.0 g per kilogram of the victim’s body weight in the form of a suspension of coal in water, it can be introduced through a probe immediately after the end of probe washing. Intravenous infusions of N-acetylcysteine and benzylpenicillin are prescribed. [17]

At the stage of primary health care, not only activated charcoal is used, but also other enterosorbents that allow you to bind and remove toxic substances: Polysorb, Enetrosgel, Enterodez. Silica-based formulations are preferred over activated carbon. Firstly, it should be used in large doses, and victims sometimes can not drink immediately a large amount of suspension. Silicon preparations act in smaller volumes, they are better tolerated. Secondly, large doses of activated carbon can interfere with intestinal motility. 

If poisoning with amanitin-containing fungi, fragments of which can be delayed in the intestine for up to four days, is assumed, total intestinal lavage is performed. Why use saline enteral solution heated to body temperature, which the patient drinks in a glass with an interval of 5-10 minutes. In total, you need to drink from two to three liters of solution. Bowel cleansing occurs naturally, the procedure of probeless intestinal lavage is carried out to "clean water". In severe patients, continuous probe intestinal lavage is performed, in some cases a double-lumen probe is administered under the control of an endoscope. The methods used are different, and they depend on the condition of the patient and the capabilities of the hospital.

Saline enteral solution is prepared immediately before use. It contains sodium compounds (phosphate, acetic acid, chloride), calcium chloride and potassium chloride, magnesium sulfate, diluted with distilled water to a chyme consistency.

At the same time, enterosorbents are used, monitoring and correction of the water-electrolyte balance is carried out by intravenous infusion.

The most complete detoxification of the gastrointestinal tract not only helps to remove the remaining poisons from its departments, but also interrupts the intestinal-hepatic circulation of toxic substances, which is especially important when poisoning with amanitine-containing mushrooms - smelly, spring or green fly agaric.

As part of detoxification measures, forced diuresis is effective, which is confirmed by a higher level of concentration of toxic substances in the urine. Its effectiveness is especially high in case of poisoning with red or panther fly agaric and in the first four days in case of poisoning with mild to moderate amanitine-containing mushrooms. Based on the toxicokinetics of amatoxins, after four days from the moment of poisoning, the use of forced diuresis is impractical. Also, this method has not proved effective in severe disorders of hemodynamics and excretory renal function.

In this case, the hemosorption method is used under the control of hemodynamic parameters. Its conduct is contraindicated in the presence of ulcers on the mucous membrane of the gastroenteric canal, severe bleeding disorders, uncontrolled decrease in blood pressure, not resolved hypovolemic disorders.

Along with hemosorption, plasmapheresis is used (removal of part of the plasma with toxic substances, purification and its return back to the bloodstream) and plasmosorption. These methods can be used at the risk of bleeding and ulcerative lesions of the mucous membrane of the stomach and intestines. Contraindications to their use are hypoproteinemia (total score less than 60g / l) and a decrease in the volume of circulating blood. They are used for poisoning with amatoxins and less dangerous fungi. In the process of treatment, it is mandatory to control the main indicators of the body's vital functions - blood pressure, pulse, electrolyte balance, hematocrit, etc.

Other detoxification methods are also used - filtration hemodialysis, new Prometheus® direct absorption technologies, but they are not yet available to the majority of the population.

Established poisoning with red (panther) fly agaric also requires mandatory measures to detoxify the body and are carried out in accordance with the general principles of treatment. But the treatment of myco-atropine (pantherinene) syndrome usually consists in eliminating poisons from the body, maintaining the balance of electrolytes and stopping psychomotor agitation, for which psychotropic drugs are used - chlorpromazole, haloperidol, benzodiazepines. Symptomatic treatment may be necessary according to the patient’s condition, but usually its volume is much less than with poisonous fly agaric poisoning.

Carrying out antidote therapy is carried out according to indications. There is no specific antidote for poisoning with fly agaric. For example, atropine is an antidote to muscarine, however, fly agaric poisoning is now known to be caused by a complex of poisons, and atropine does not completely stop its toxic effect, although sometimes its administration is sometimes considered appropriate for fly agaric poisoning. 

For poisoning with a pale toadstool and other fungi containing amanitins, high doses of sodium benzylpenicillin are administered during the first three days. The drug is administered intravenously in a daily dose of 300 thousand-1000 thousand units per kilogram of the victim’s weight. Such antidote therapy is consistent with WHO recommendations, but its effectiveness remains open to question. [18]

Basically, antidote therapy is carried out in case of poisoning with especially dangerous species of fly agaric, the toxins of which cause irreversible disturbances in organs with intensive protein synthesis. This therapy in the toxicogenic stage has two meanings: as antidote and organ-preserving.

Basically, hepatoprotective drugs are used. Herbal preparations containing the extract of the fruits of milk thistle are recommended. The active substance in this case is silymarin. For example, oral administration of Legalon capsules can be prescribed - two pieces three times a day, which corresponds to 0.84 g of silymarin. [19], [20]

If no more than two days have passed since the poisoning, the solution with the indicated active substance can be prescribed intravenously for several days in a daily dose of 20 to 50 mg per kilogram of the victim’s weight. Since oral administration during the period of indomitable vomiting or enteric detoxification with enterosorbents is useless. Then the patient is transferred to an oral dose of one or two capsules three times every day for several months.

Milk thistle fruit extract binds free radicals in hepatocytes, reducing their toxicity and interrupting the reaction of fat peroxidation. This is a prevention of further penetration of amatoxins into hepatocytes and their further destruction. Damaged liver cells under the action of the extract begin to more actively synthesize structural and functional proteins and phospholipids, which is facilitated by the specific effect of RNA polymerase stimulation. As a result, hepatocyte membranes are strengthened, their permeability decreases. This prevents the loss of transaminases and accelerates the restoration of normal liver tissue.

As part of hepatoprotective therapy, medications are prescribed: orally, two capsules three times a day - Hepatosan, Essentiale; 10 ml heptral intravenously; intravenously / intraportally in 10 ml Essential.

In addition, it is imperative that every morning one and one vitamin of group B is administered daily (intramuscularly or intravenously), alternately: 5% thiamine solution, 1 ml each; 5% pyridoxine solution in the same dose; 200 mcg cyanobalamin.

Thioctic acid can be prescribed by injection of a 0.5% solution of 5-8 ml or orally in capsules - two four times a day. It helps regulate the metabolism of fats and carbohydrates.

Protective metabolic hepatic therapy is performed by prescribing succinic acid. This is necessary for mushroom poisoning with amatoxins. It allows you to establish metabolism associated with energy metabolism. Effective is the use of Remaxol containing, in addition to succinic acid, meglumine, riboxin, methionine, nitacid. It accelerates the transition of anaerobic to aerobic processes. He is prescribed drip. The daily dose is 0.4-0.8 liters. Such therapy is carried out from three days to two weeks.

Antihypoxants, for example, Cytoflavin, antireflux drugs, for example, Kvamatel, proton pump inhibitors - Omeprazole, can be prescribed.

In case of poisoning with amanitine-containing fly agarics, antibiotics are prescribed to suppress the pathogenic flora in the intestine (preferably from the group of cephalosporins) and probiotics to normalize the intestinal biocenosis.

The somatogenic stage is also characteristic of poisoning with amanitin-containing fungi, after which lesions of the liver, kidneys, and brain develop. Complications can also be pneumonia and secondary cardiovascular failure. Treatment consists in removing endotoxicity caused by organ damage and metabolic disorders; prevention of multiple organ disorders (rehabilitation treatment); drug correction of the effects of metabolic disorders. When prescribing drugs and treatment regimens, they are guided by the somatic condition of the victim.

Medical rehabilitation after poisoning with mushrooms, especially amanitine-containing, should include a whole range of therapeutic measures aimed at restoring the normal functioning of internal organs, restoring their self-regulation mechanisms and preventing possible complications. Physiotherapeutic treatment during this period should be a good help, allowing to reduce the drug load and accelerate recovery. Methods of exposure to physical factors are prescribed individually, depending on the somatic condition of the patient, taking into account contraindications.

To restore the mucous membrane of the gastrointestinal tract, heat therapy, ultrasound, and electrical procedures are used. The delivery of drugs to the organs is much more efficient using electrophoresis and phonophoresis. With damage to the liver and kidneys, inductothermy, the effect of pulsed and alternating currents can be prescribed.

Alternative treatment

Amanita poisoning treated independently with alternative means is very risky. Unless with very light poisoning. But in the recovery period, you can safely use alternative means.

The following solution can be recommended as first aid: per liter of boiled cold water - a teaspoon of sea salt and baking soda, as well as eight teaspoons of sugar. Stir until completely dissolved. The solution is drunk in three doses after washing the stomach and enema.

In case of mushroom poisoning, alternative healers recommended drinking a decoction of licorice root. Contains glycyrrhizin (also called glycyrrhizic acid or glycyrrhizic acid) and a mixture of potassium and calcium salts of glycyrrhizic acid. [21]This plant has long been used to neutralize the effects of many toxic substances, in addition, glycyrrhizic acid stimulates the adrenal glands and, therefore, the production of endogenous steroid hormones with anti-inflammatory effects, as well as the work of the pancreas and, accordingly, the synthesis of insulin. And a decoction of licorice root increases pressure, immunity and has a slight laxative effect.

To prepare the broth, take two tablespoons of the powder from the dried roots of the plant for 500 ml of boiling water, simmer over low heat in an enamel pan, then insist for an hour and a half. Filter and give the patient a third of a glass three times a day.

Milk thistle is used in cases of poisoning and in official medicine. There is evidence that milk thistle has hepatoprotective properties due to a number of mechanisms: antioxidant activity, blocking of toxins at the membrane level, enhanced protein synthesis, antifibriotic activity, and possible anti-inflammatory or immunomodulating effects. [22]On its basis, a number of drugs are produced. Herbal treatment of inflammatory and dystrophic processes in the liver is not complete without this plant. Milk thistle herb relieves intoxication in case of poisoning and helps to restore the mucous membrane of the gastrointestinal tract. From it you do not even need to make infusions and decoctions. Powders from ground dry seeds of milk thistle are sold in pharmacies. It is added to food or just swallow a teaspoon and washed down with water. Up to four teaspoons of powder can be eaten per day. Milk thistle can cause allergic reactions and have a laxative effect. This plant is not recommended for acute inflammation of the pancreas and gall bladder, severe renal failure and liver cirrhosis, urolithiasis, stones in the gall bladder, as well as for mental patients and epileptics. 

The detoxifying and anti-inflammatory properties of elecampane have. [23]An infusion is prepared from its roots. To do this, boil boiling water (200 ml) two tablespoons of crushed dry roots of the plant and allow to stand for 20 minutes. Filter and take a tablespoon four times a day.

Powder from the dried roots of elecampane is taken a pinch daily to restore the function of the gastrointestinal tract and liver.

Homeopathy

The homeopathic treatment of poisoning has the same goals - removing the poison from the body, neutralizing the absorbed poison and stopping complications after poisoning. Poisons are removed from the gastrointestinal tract by the same methods - they cause vomiting, give a laxative, and put an enema.

There are no general rules. Symptomatic agents are used that support the activity of the heart, respiratory functions, stopping excitation. Given that mushroom poisoning mainly requires modern resuscitation measures, in the acute period it is worth entrusting your life to official medicine. In the rehabilitation period, homeopathy can help restore organ function. But the treatment should be prescribed by a professional.

Prevention

Avoiding poisoning with fly agaric is not difficult. You need to be extremely careful on a "silent hunt" and not put unfamiliar mushrooms in a basket. At home, they need to be carefully sorted and reviewed again.

Do not leave small children unattended in places where fly agaric can grow.

In addition, you should not use fly agaric as psychedelics and do not buy counterfeit alcohol.

Forecast

Mortality in cases of poisoning with red and panther fly agarics is practically not found. It mainly deals with mixed poisoning. The most fatal cases of poisoning by flybane fly agaric, statistics link the vast majority of cases of fatal poisoning with the use of pale grebe (up to 90%).

The risk of death from fly agaric poisoning is greater in a child who will receive a higher dose of toxic substances per kilogram of weight than an adult. Amanita poisoning is also more dangerous for the elderly.

The prognosis of the outcome of an accident very much depends on the timeliness of assistance.