First aid for poisoning with pale toadstool: gastric lavage and repeated intake (every two to four hours) 22-50 g of activated carbon (in the form of an aqueous suspension); children - 0.5-1 g / kg.
Activated charcoal can reduce absorption of amatoxins if taken early after ingestion, and it can also prevent reabsorption of toxins after a few hours, as amatoxins undergo enterohepatic recirculation. A dose of 1 g / kg can be administered every 2–4 hours.
All patients with suspected death cap poisoning should be immediately hospitalized in the intensive care unit, where poisoning is treated and symptomatic intensive care for poisoning is carried out .
A direct antidote to toadstool poisoning has not yet been found, but drugs such as Silibinin (a drug based on the biologically active substance of silymarin spotted milk thistle), N-acetylcysteine and Benzylpenicillin (Penicillin G) have been successfully used.
Silibinin is administered by continuous infusion for two to four days (20-50 mg / kg per day). Silymarin in the literature has mostly used both a pharmaceutical form available in Europe as an intravenous preparation and an over-the-counter raw milk thistle extract used in North America. Its mechanism of action is believed to be an inhibitor of the OAT-P transporter, which slows down the penetration of amatoxin into the liver. Doses are 1 g orally four times a day or its purified alkaloid silibinin intravenously 5 mg / kg intravenously for one hour, followed by 20 mg / kg / day as a continuous infusion.
N-acetylcysteine is injected intravenously (within 20 hours with a change in dosage) and benzylpenicillin - 500,000-1,000,000 IU / kg for two days.
With liver necrosis, Western medicine can save a patient with mushroom poisoning from the Amanitaceae family by transplanting a donor organ.
With the development of acute kidney failure, hemodialysis is performed. It may be necessary to maintain respiratory function by artificial ventilation of the lungs.
Neurological symptoms are treated with sedatives of the benzodiazepine group, and barbiturates are used for poorly controlled seizures.