Fly poisoning

There are many different mushrooms in the Amanita family (amanitaceae), and not all of them are poisonous, there are also edible ones. However, when you hear the word fly agaric, only one of them immediately comes to mind. Even small children know this beautiful mushroom by sight from pictures in children's books. Everyone knows that it is poisonous. A bright red glossy cap with white convex dots and a pleated collar on the stem of a mature mushroom - this appearance cannot be confused with anything. Therefore, in the post-Soviet space, accidental poisoning with fly agaric, namely the classic red one, is a rarity. In European countries, such cases are more common during the mushroom season (late summer - early autumn), since mushrooms are eaten that at some stages of their development vaguely resemble the red fly agaric, for example, the Caesar's mushroom - an extremely tasty edible representative of the fly agaric family, growing in the south of Europe.

Other, more unsightly fly agarics with white, greenish-brown and gray-brown caps end up in mushroom pickers' baskets somewhat more often. They can be confused with edible mushrooms - champignons, russula, edible and tasty gray-pink or thick fly agarics. Deadly representatives of the fly agaric family are fly agarics - stinking and spring, as well as their closest relative, the death cap, which is essentially a green fly agaric.

Descriptions and photographs of poisonous mushrooms are widely disseminated, however, it is impossible to rule out an accident associated with eating a fly agaric. Our article will tell you how poisoning with different types of fly agarics manifests itself and how to help the victim. Although, of course, the best preventive measure is to pay utmost attention to the contents of the basket.

Amanita muscaria (fly agaric) is a spectacular and well-known ectomycorrhizal mushroom that is native and common in temperate coniferous and deciduous forests of the northern hemisphere. In recent decades, it has been introduced by forestry to the southern hemisphere and has consequently become a cosmopolitan species (Reid and Eicker 1991). Fly agaric is widely known to be psychoactive due to the hallucinogenic effects of some of its compounds.

Epidemiology

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

Statistics in recent decades have recorded virtually no fatal poisonings by red and panther fly agarics, since the concentration of toxic substances in the case of accidental ingestion of fly agarics was insufficient for this. Mushroom poisonings are quite common, especially in summer and autumn, but fly agaric (Amanita muscaria) and Amanita pantherina are a rather rare cause of these poisonings. Most often, fly agarics are the cause of intentional poisoning. 95% of deaths from mushroom consumption worldwide are caused by mushrooms containing amatoxin, in particular fly agarics. [ 2 ]

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

But such representatives of the fly agaric family as the death cap, white cap and vernal cap, otherwise known as fly agarics: green, stinking and vernal cap lead the ranking of the most dangerous mushrooms. They are very poisonous, a third of the cap is enough to make a mushroom dish completely inedible. More than half of the cases of poisoning by these mushrooms end in death. In addition, a poisonous mushroom spoils even its touch to edible neighbors in the basket.

Causes fly agaric poisoning

To be poisoned by a fly agaric, you need to eat it and, most often, not just one mushroom, but several - dried, boiled, fried, raw, or drink a strong mushroom broth or infusion. A lethal dose for an adult is about 15 caps of red fly agaric. So, if one small fly agaric of this type gets into a large frying pan with edible fried mushrooms, then there may not be a noticeable deterioration in the condition, especially in adults.

History has it that the inhabitants of the Kamchatka Peninsula used red fly agarics "for fun" during feasts. This was written about by S.P. Krasheninnikov, a Russian explorer of Siberia and Kamchatka (18th century). They drank fly agaric infusion or swallowed dried mushroom caps. The result was a dose-dependent effect similar to different degrees of intoxication. Consuming no more than four mushrooms caused vigor, joy, lightness, about ten - a state similar to delirium, accompanied by hallucinations and delirium. Only adult men "had fun" in this way. There are other reports that fly agarics were used to make vodka, immoderate consumption of which often ended in psychomotor agitation with human casualties or fatal poisoning. Fly agarics were used by shamans of different nations to achieve a state of trance.

These historical facts are widely known, the hallucinogenic properties of poisonous mushrooms are still used today to achieve a narcotic effect. Intentional use of them in this capacity can cause poisoning of a toxicomaniac. In addition, it is possible that even today counterfeit low-proof vodka is mixed with "fly agaric" for strength, and it is quite possible to poison yourself with it.

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

Traditional healers use preparations made from fly agarics, which can also cause poisoning if the rules for taking them are not followed.

Risk factors for accidental poisoning with fly agaric are seasonal and related to mushroom picking. In the old days, in rural life, they were used for their intended purpose - to kill flies by setting out dishes with mushroom broth or fried mushrooms as bait in the summer. Small children were sometimes poisoned by these fly poisons. Nowadays, such use of fly agarics is no longer relevant.

A small child left unattended can eat a raw mushroom due to childish curiosity and a desire to try everything "by tooth", or an inexperienced mushroom picker can collect very young fly agarics, mistaking them for good mushrooms, and feed them to the family. Although such mistakes are most often made in European countries, for example, in France or Italy, where they collect the Caesarian mushroom, which looks like a red fly agaric.

Rather, an inattentive mushroom picker may accidentally end up with small panther fly agarics or more mature specimens with washed-out spots after heavy rain. The mushroom has caps of all shades of brown and is easier to confuse with those that can be eaten. It also looks like edible fly agarics - gray-pink and thick. However, unlike them, the flesh of the mushroom does not emit a very strong unpleasant smell and is bitter in taste.

Toadstools - stinking, spring and green are confused with russula and champignons.

Pathogenesis

The pathogenesis of poisoning is reduced to the action of several toxic substances and is described as a syndrome that constitutes a specific clinical picture. Such types of fly agarics as red and panther cause myco-atropine syndrome. The composition of the poisons in the specified types of fly agarics is somewhat different, but the total toxic effect of the syndrome they cause is defined as cholinolytic. [ 6 ]

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

The most well-known toxic substance is muscarine, isolated at the end of the 19th century and considered the main culprit of poisoning when using fly agarics, attributing to it the ability to cause all the symptoms of poisoning, including mental disorders. However, a more detailed study showed that muscarine is far from the main toxic substance in the fly agaric. In its pure form, it causes a pronounced cardiotoxic effect - it dilates blood vessels, lowering blood pressure and reducing the minute volume of blood, which can, when large doses are received, 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, causing suffocation in large doses. But there is very little muscarine and its derivatives in fly agarics, its effects are not leading.

Psychotropic substances contained in mushrooms in significant quantities turned out to be other components – ibotenic acid and its metabolic products: muscimol and muscazone. They easily cross the blood-brain barrier and have a psychomimetic effect. Ibotenic acid is related to glutamic (excitatory amino acid), muscimol is similar in structure to the inhibitory mediator γ-aminobutyric acid, due to which these substances block the receptors of two important neurotransmitters, blocking ion channels and disrupting metabolic processes in the brain. Depending on the dose taken, the victim develops dissociative disorders, hypnotic states, acute psychoses. In addition, unchanged ibotenic acid is a neurotoxin and causes the death of brain cells. A. muscaria can affect the activity of neurons in the central areas of the brain. [ 8 ], [ 9 ]

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

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

When eating toadstools (green, stinking, spring), phalloidin syndrome develops. The toxic substances responsible for the pathogenesis of poisoning with these mushrooms are amatoxins, which block the cellular synthesis of protein molecules, and phallotoxins, which destroy the membranes of liver cells and inhibit mitochondrial processes of oxidative phosphorylation. The action of amatoxins is most destructive for organs whose cells intensively produce protein: intestines, liver, kidneys, pancreas, lymphoid tissue. Enterocytes encounter the poison first, but symptoms of acute gastroenteritis, indicating poisoning, develop no earlier than six hours after eating the mushrooms.

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

The damaging combined action of amatoxins and phallotoxins causes necrotic changes in the intestinal mucosa, it loses its barrier function, which leads to a disruption of the intestinal biocenosis in favor of the proliferation 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 liver cells.

The stinking fly agaric is a white or grayish-white mushroom. It is also called the white toadstool. It emits an unpleasant odor similar to chlorine. It is this feature that saves most inexperienced mushroom pickers from eating it. Edible mushrooms that can be confused with the stinking fly agaric, such as champignons, do not have such a smell. A deadly mushroom containing amatoxins and phallotoxins. Their combined effect causes fatal poisoning when eating both the white (spring) fly agaric and the green one, better known as the death cap.

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

Symptoms fly agaric poisoning

The first signs are the symptoms characteristic of poisoning, weakness, profuse sweating, nausea with strong salivation, vomiting, diarrhea, a constant rumbling in the stomach, and everyone around you can hear it. 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 the mushrooms. The maximum time interval before the signs of poisoning appear is six hours. Neurotoxic effects are manifested by dizziness, miosis, double vision, spots before the eyes and other visual impairments. In severe cases, inadequate behavior, impaired consciousness, delusional-hallucinatory disorder are observed, respiratory function and heart function are impaired. Cerebral edema, coma and death may occur, mainly from acute heart failure.

Non-fatal poisoning with red fly agaric is comparable to a state of severe alcohol intoxication. The patient is excited, he experiences bouts of unbridled joy, sometimes unexpectedly replaced by malicious antics. From the outside, the patient's behavior is incomprehensible to others, his perception of reality is impaired, he is under the influence of hallucinations - auditory, visual, olfactory, but can still react to events and answer questions. In the last stage, the patient is completely in an illusory world, delirious, does not give an account of his actions, after which he falls into a deep narcotic sleep. Upon waking up, he does not remember anything and feels broken. [ 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, difficulty breathing, and increased pulse rate. The pupils become dilated, that is, the symptoms of atropine poisoning prevail. At the same time, and sometimes earlier, psychotic symptoms appear, which are manifested by a state of euphoria and hallucinatory syndrome. Patients are usually very excited, there may be convulsions. In general, with poisoning with panther fly agaric, the symptoms of a disorder of the central nervous system are more pronounced. Excitement with a hallucinatory-delusional component gradually turns into a state of inhibition and apathy up to an unconscious state. [ 11 ]

In folk medicine, red and panther fly agarics are used. Poisoning with fly agaric tincture can occur when taken internally as a medicine. When used externally for compresses and rubbing for radiculitis and rheumatism, poisoning usually does not occur if the integrity of the skin is not damaged. But if there is damage to the skin surface, poisoning cannot be ruled out. The symptoms of poisoning with fly agaric tincture are identical to those caused by eating raw or dried mushrooms - digestive disorders and brain phenomena of varying severity.

Mild intoxication usually passes within a few hours, in severe cases a comatose state develops and the victim may die. [ 12 ]

Poisoning with stinking fly agaric (white toadstool) and other amanitine-containing mushrooms is initially asymptomatic. The first, latent period lasts at least six hours, and in some cases extends to two days. The destructive work of the poisons already occurs in the absence of symptoms. It was noted that during this period, the victims were overly excitable and anxious, however, in the absence of other manifestations, this was not enough to seek medical attention.

Therefore, if vomiting suddenly begins against the background of unexpected weakness, and very often, several times a minute, first with food, then with a cloudy liquid with fragments of bile (while the patient has eaten mushrooms during the last two or three days), it is necessary to urgently seek help. This is how the second stage begins - acute gastroenteritis. Diarrhea and severe stabbing pains in the abdomen may be late and begin in a few hours. In severe cases, cholera-like symptoms develop, blood is observed in watery stools, countless urges to defecate, severe dehydration, accompanied by dry mouth and thirst. The patient's condition may be aggravated by heartburn, muscle pain, heart problems, 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 pain in the abdomen. Already at this stage, neurological symptoms may appear - myoclonus, tonic-clonic seizures (more common in childhood); impaired sensitivity, coordination of movements, coordination, clouding of consciousness, hallucinations, delirium.

Then comes a period of false improvement in the condition, the manifestations of gastroenteritis subside, but weakness, hypotension, decreased appetite, muscle spasms and residual symptoms of dehydration remain. The third stage of apparent well-being is misleading for many victims, since the patient feels relief 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, bleeding gums, and symptoms of encephalopathy appear. At first, the whites of the eyes turn yellow, later, with an increase in the level of bilirubin in the blood, the skin becomes jaundiced. The skin is dry and itchy, bad breath appears, weakness increases, appetite disappears, the patient suffers from insomnia, and pain is felt on palpation on the right. Neurological symptoms join in: an excited state and inhibition, inadequate reactions, hallucinations. Blood clotting is impaired, hemorrhagic syndrome intensifies - spontaneous bruises appear, gums bleed, women may have uterine bleeding, patients of either sex may have blood in the vomit, feces, and urine. Body temperature can reach pyretic values, or it can be greatly reduced. Dysfunction of the liver and kidneys progresses, respiratory failure and depression of consciousness develop. The patient may die as a result of irreversible damage to the intestines, liver and kidneys, thrombohemorrhagic syndrome, adrenal insufficiency. These vital organs fail approximately on the eighth or tenth day.

With timely symptomatic therapy to support organ functions using detoxification techniques, the fifth stage occurs – recovery.

Poisoning with white fly agaric (spring), as well as its green brother (death cap) occurs according to the same scenario. The duration of the recovery stage is determined by the severity of the intoxication suffered and often requires a long time.

Complications and consequences

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

In addition, survivors may develop irreversible damage to internal organs, which will lead to chronic diseases that require constant medical monitoring, drug therapy, and certain restrictions in diet and physical activity, which reduces the quality of life. Liver transplantation is often 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 caps, which is enough to kill a healthy adult). After 24–48 hours of ingestion, patients develop gastrointestinal symptoms, jaundice, renal failure, and coma. [ 14 ], [ 15 ] Overall mortality is 5–40%. Children require a much smaller dose, as do the elderly and chronically ill. The toxic content of fly agarics varies depending on the place where the mushrooms were collected, their age, and the method of preparation. Accordingly, the severity and consequences of poisoning depend on this. Aggravating factors include the resistance of fly agaric toxins to drying and cooking.

Toadstools (stinking, 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 edible mushrooms that were lying nearby in a basket can poison you.

Diagnostics fly agaric poisoning

Poisoning with fly agarics manifests itself, first of all, in gastrointestinal disorders. Other symptoms can be used to guess what kind of poisoning was caused. The time during which severe symptoms developed is of great importance. 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 remains of food or the remaining raw mushrooms, although usually not the entire collection consists of fly agarics and toadstools. In addition, a consultation with an experienced mycologist is necessary.

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

Instrumental diagnostics can provide certain information about the condition of internal organs. This mainly includes ultrasound examination of the liver, Dopplerography and radioisotope hepatography.

People who have symptoms of acute gastroenteritis should seek medical attention for poisoning by fly agaric mushrooms.

Differential diagnosis

Differential diagnostics are carried out with other food poisonings; intoxications with acetaminophen, organophosphorus compounds, heavy metals, drugs that lower blood glucose levels; acute appendicitis; intestinal infections, in particular, cholera; non-infectious gastroenteritis; manifestation of viral hepatitis, etc.

Treatment fly agaric poisoning

In most cases, a victim of mushroom poisoning is prescribed symptomatic and supportive therapy. Properly rendered first aid is of great importance. What to do in case of fly agaric poisoning? As with any toxic substance entering the body, first of all, you need to help get rid of it as quickly as possible. That is, wash the stomach, repeatedly induce vomiting, give an enterosorbent (activated carbon is almost always in the first aid kit), a laxative and call an ambulance. Before the team arrives, the victim is put to bed, covered warmly, given plenty of fluids.

If mushroom poisoning is suspected, the patient is hospitalized. Given that the clinical picture of poisoning by different mushrooms is similar, the general approach to providing assistance is initially the same in all cases. Subsequently, the dynamics of the poisoning course allows determining the optimal treatment methods.

In the toxicogenic stage of poisoning, efforts are primarily focused on eliminating toxic substances from all distribution environments. In the first hours, the patient undergoes gastric lavage, laxatives are prescribed, and, in addition, enteral detoxification of the body is performed. Activated carbon is used as an enterosorbent at a rate of 0.5-1.0 g per kilogram of the victim's body weight in the form of a carbon suspension in water, which can be administered through a tube immediately after the end of the tube lavage. Intravenous infusions of N-acetylcysteine and benzylpenicillin are prescribed. [ 17 ]

At the stage of primary health care, not only activated carbon is used, but also other enterosorbents that allow binding and removing toxic substances: Polysorb, Enterosgel, Enterodez. Preparations based on silicon dioxide are more preferable than activated carbon. Firstly, it should be used in large doses, and victims sometimes cannot drink a large amount of suspension at once. Silicon preparations act in smaller volumes, they are better tolerated. Secondly, large doses of activated carbon can disrupt intestinal peristalsis.

If poisoning with amanitine-containing mushrooms is suspected, fragments of which can linger in the intestines for up to four days, a total intestinal lavage is performed. For this, a saline enteral solution heated to body temperature is used, which the patient drinks in a glass at intervals of 5-10 minutes. In total, you need to drink two to three liters of solution. Cleansing of the intestines occurs naturally, the procedure of non-tube intestinal lavage is carried out until the "waters are clear". Seriously ill patients undergo continuous tube intestinal lavage, in some cases a double-lumen probe is inserted under the control of an endoscope. Different methods are used, and they depend on the patient's condition and the capabilities of the medical institution.

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

At the same time, enterosorbents are used, and water-electrolyte balance is monitored and corrected using intravenous infusions.

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

Forced diuresis is effective in detoxification measures, which is confirmed by a higher level of concentration of toxic substances in the urine. It is especially effective in cases of poisoning with red or panther fly agarics and in the first four days of mild to moderate poisoning with amanitin-containing mushrooms. Based on the toxicokinetics of amatoxins, forced diuresis is not advisable after four days from the moment of poisoning. This method has also not proven effective in cases of severe hemodynamic disorders and renal excretory function.

In this case, the hemosorption method is used under the control of hemodynamic parameters. Its implementation is contraindicated in the presence of ulcers on the mucous membrane of the gastrointestinal tract, severe blood clotting disorders, uncontrolled decrease in blood pressure, and uncorrected hypovolemic disorders.

Along with hemosorption, plasmapheresis (removal of part of the plasma with toxic substances, purification and return of it back to the bloodstream) and plasmasorption are used. These methods can be used in case of risk of bleeding and ulcerative lesions of the mucous membrane of the stomach and intestines. Contraindications to their use are hypoproteinemia (total indicator less than 60 g/l) and decrease in the volume of circulating blood. They are used in case of poisoning with amatoxins and less dangerous mushrooms. During the treatment, monitoring of the main vital signs of the body is mandatory - blood pressure, pulse, electrolyte balance, hematocrit, etc.

Other methods of detoxification are also used – filtration hemodialysis, new direct absorption technologies Prometheus®, 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 is carried out according to the general principles of treatment. But the therapy of myco-atropine (pantherine) syndrome usually consists of eliminating poisons from the body, maintaining the balance of electrolytes and stopping psychomotor agitation, for which psychotropic drugs are used - aminazine, haloperidol, benzodiazepines. Symptomatic treatment may be needed according to the patient's condition, but usually its volume is much less than in case of poisoning with toadstools.

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

In cases of poisoning with death cap and other mushrooms containing amanitins, high doses of sodium benzylpenicillin are administered for the first three days. The drug is administered intravenously at a daily dose of 300,000-1,000,000 IU per kilogram of the victim's weight. This antidote therapy complies with WHO recommendations, but its effectiveness remains questionable. [ 18 ]

Antidote therapy is mainly used for poisoning with especially dangerous fly agaric species, the toxins of which cause irreversible damage to organs with intensive protein synthesis. This therapy in the toxicogenic stage has a dual meaning: as an antidote and organ-preserving.

Basically, hepatoprotective drugs are used. Herbal preparations containing milk thistle extract 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, a solution with the active substance indicated can be administered intravenously for several days at a daily dose of 20 to 50 mg per kilogram of the victim's weight. Since oral administration during the period of uncontrollable vomiting or enteral detoxification with enterosorbents is useless. Then the patient is transferred to oral administration of one or two capsules three times a day for several months.

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

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

In addition, it is essential to administer one vitamin of group B (intramuscularly or intravenously) every day, in the morning and evening, in turn: 5% thiamine solution, 1 ml; 5% pyridoxine solution, in the same dose; cyanocobalamin, 200 mcg.

Thioctic acid can be prescribed in injections of 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 liver therapy is carried out by prescribing succinic acid. This is necessary in case of poisoning with mushrooms containing amatoxins. It helps to establish metabolism associated with energy exchange. Remaxol, which contains meglumine, riboxin, methionine, and nitacide in addition to succinic acid, is effective. It accelerates the transition of anaerobic processes to aerobic ones. It is administered by drip. The daily dose is 0.4-0.8 l. Such therapy is carried out from three days to two weeks.

Antihypoxants, such as Cytoflavin, antireflux drugs, such as Quamatel, proton pump inhibitors – Omeprazole may be prescribed.

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

The somatogenic stage is also typical for poisoning with amanitin-containing mushrooms, after which liver, kidney, and brain damage develop. Pneumonia and secondary cardiovascular failure may also become complications. Treatment consists of relieving endotoxication caused by organ damage and metabolic disorders; preventing multiple organ disorders (restorative treatment); and drug correction of the consequences of metabolic disorders. When prescribing drugs and treatment regimens, the somatic condition of the victim is taken into account.

Medical rehabilitation after mushroom poisoning, especially amanitine-containing ones, 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 speed up recovery. Methods of influencing physical factors are prescribed individually, depending on the somatic condition of the patient, taking into account contraindications.

Heat therapy, ultrasound, and electrical procedures are used to restore the mucous membrane of the gastrointestinal tract. Delivery of drugs to organs is much more effective with the help of electro- and phonophoresis. In case of liver and kidney damage, inductothermy, exposure to pulsed and alternating currents may be prescribed.

Folk remedies

It is very risky to treat fly agaric poisoning on your own using folk remedies. Except for very mild poisonings. But during the recovery period, you can safely use folk remedies.

As a first aid, we can recommend the following solution: 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. Drink the solution in three doses after washing the stomach and an enema.

In case of mushroom poisoning, folk healers recommended drinking a decoction of licorice root. It 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 action, as well as the pancreas and, accordingly, the synthesis of insulin. And a decoction of licorice root helps to increase blood pressure, immunity and has a mild laxative effect.

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

Milk thistle is used for poisoning and in official medicine. There is evidence that milk thistle has hepatoprotective properties due to a number of mechanisms: antioxidant activity, blockade of toxins at the membrane level, increased protein synthesis, antifibriotic activity and possible anti-inflammatory or immunomodulatory effects. [ 22 ] A number of drugs are produced on its basis. Herbal treatment of inflammatory and dystrophic processes in the liver is not complete without this plant. Milk thistle herb relieves intoxication in poisoning and helps restore the mucous membrane of the gastrointestinal tract. There is no need to make infusions and decoctions from it. Pharmacies sell powder from ground dry milk thistle seeds. It is added to food or simply swallowed a teaspoon and washed down with water. You can eat up to four teaspoons of powder per day. Taking milk thistle can cause allergic reactions and have a laxative effect. This plant is not recommended for use in cases of acute inflammation of the pancreas and gall bladder, severe renal failure and liver cirrhosis, urolithiasis, gallstones, as well as for mentally ill and epileptic patients.

Elecampane has detoxifying and anti-inflammatory properties. [ 23 ] An infusion is prepared from its roots. To do this, brew two tablespoons of crushed dry roots of the plant with boiling water (200 ml) and let stand for 20 minutes. Strain and take a tablespoon four times a day.

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

Homeopathy

Homeopathic treatment of poisoning pursues 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 using the same methods - inducing vomiting, giving a laxative, giving an enema.

There are no general rules. Symptomatic means are used to support cardiac activity, respiratory function, and relieve agitation. Considering that mushroom poisoning mainly requires modern resuscitation measures, it is worth entrusting your life to official medicine in the acute period. In the rehabilitation period, homeopathy can help restore organ function. But a professional should prescribe treatment.

Prevention

Avoiding poisoning with fly agaric is not difficult. You need to be extremely careful during the "quiet hunt" and not put unfamiliar mushrooms in your basket. At home, you need to carefully sort them out and review them again.

Do not leave small children unattended in areas where fly agarics may grow.

In addition, one should not use fly agarics as psychedelics and not buy counterfeit alcohol.

Forecast

Fatality in poisoning with red and panther fly agarics is almost never encountered. It mainly concerns mixed poisonings. The most fatal cases are poisoning with toadstools, statistics link the overwhelming majority of cases of fatal poisoning with the use of death cap (up to 90%).

The risk of death from fly agaric poisoning is greater for a child, who will receive a higher dose of toxic substances per kilogram of weight than an adult. Also, fly agaric poisoning is more dangerous for older people.

The prognosis for the outcome of an accident depends greatly on the timeliness of assistance.