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Characteristics of Patients Presenting to the Emergency Department with Mushroom Poisoning and the Role of Laboratory Parameters in Determining Prognosis

Year 2023, Volume: 13 Issue: 3, 337 - 345, 21.09.2023
https://doi.org/10.33631/sabd.1292429

Abstract

Aim: In this study it is aimed to investigate the general characteristics of the patients of mushroom poisoning in the emergency department and to determine the possible prognostic factors.
Material and Methods: This study was conducted by retrospectively examining the records of patients who applied to the emergency department of a university hospital in Samsun, Turkey, with mushroom poisoning in 6 years. Patients were grouped using models that predict mortality and the severity of poisoning. Model for end stage liver diseases (MELD) scoring and poisoning severity score (PSS) were used for this purpose. All data obtained from this study were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows 15.0 package program.
Results: Liver failure developed in 16 of 471 patients who applied with mushroom poisoning. The median symptom onset time was 2 hours in 455 patients who did not develop liver failure, and the median symptom onset time was 9.5 hours in 16 patients who developed liver failure. When the patients were classified according to PSS, 91.1% of patients applied with PSS 1, while 2.1% of them applied with severe symptoms. 93.6% of the patients were with a mild MELD score.
Conclusion: The most common clinical finding is nausea and vomiting. The appearance of symptoms within 2 hours is an indicator of a good prognosis. According to the MELD score, the severity of the disease increases as the BUN value increases. At the same time, high BUN and amylase levels mean a life-threatening poisoning according to PSS.

References

  • Gold JAW, Kiernan E, Yeh M, Jackson BR, Benedict K. Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions - United States, 2016-2018. MMWR Morb Mortal Wkly Rep. 2021; 70(10): 337-41.
  • Brandenburg WE, Ward KJ. Mushroom poisoning epidemiology in the United States. Mycologia. 2018: 110(4); 637-41.
  • Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005; 33(2): 427-36.
  • Yu JW, Wang GQ, Li SC. Prediction of the prognosis in patients with acute-on-chronic hepatitis using the MELD scoring system. J Gastroenterol Hepatol. 2006; 21(10): 1519-24.
  • Persson HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998; 36(3): 205-13.
  • Kakisaka K, Kataoka K, Onodera M, Suzuki A, Endo K, Tatemichi Y, at al. Alpha-fetoprotein: A biomarker for the recruitment of progenitor cells in the liver in patients with acute liver injury or failure. Hepatol Res. 2015; 45(10): 12-20.
  • Yardan T, Baydin A, Eden AO, Akdemir HU, Aygun D, Acar E, et al. Wild mushroom poisonings in the Middle Black Sea region in Turkey: analyses of 6 years. Hum Exp Toxicol. 2010; 29(9): 767-71.
  • Hocaoglu N, Kalkan Ş, Tunçok Y. Mushroom poisonings reported to the Dokuz Eylul University drug and poison information center. Turk J Emerg Med 2010; 10(3): 119-25.
  • Erdur B, Türkçüer İ, Ergin A, Canbora PT, Bozkır M. Assessment of mushroom poisoning cases in Denizli in 2006. Turk J Emerg Med 2007; 7(3): 109-14.
  • Cassidy N, Duggan E, Tracey JA. Mushroom poisoning in Ireland: the collaboration between the national poisons information centre and expert mycologists. Clin Toxicol (Phila). 2011; 49(3): 171-6.
  • Badsar A, Taramsari MR, Amir Maafi A, Rad MR, Chatrnour G, Jahromi SK. Mushroom poisoning in the southwest region of the caspian sea, Iran: a retrospective study. Iranian Journal of Toxicology 2013; 7(20): 798-803.
  • Sönmez E, Karakuş A, Çavuş UY, Civelek C, İpek G, Zeren C. Evaluation of intoxication cases admitted to emergency department of a university hospital. Dicle Tıp Derg. 2012; 39(1): 21-6.
  • Çevik AA, Ünlüoğlu İ, Ergün N, Şahin A. Poisoning severity scores of cases with mushroom poisoning presenting to the emergency department. Turk Journal Emergency Medical. 2007; 7(3): 102-8.
  • Goldfrank L. Goldfrank’s toxicologic emergencys 9th edition. Mc Graw Hill 2011.
  • Garcia J, Costa VM, Carvalho A, Baptista P, de Pinho PG, de Lourdes Bastos M, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. 2015; 86: 41-55.
  • Karvellas CJ, Tillman H, Leung AA, Lee WM, Schilsky ML, Hameed B, et al. Acute liver injury and acute liver failure from mushroom poisoning in North America. Liver Int. 2016; 36(7): 1043-50.
  • Iliev Y, Andonova S, Akabaliev V. Our experience in the treatment of acute Amanita phalloides poisoning. Folia Med (Plovdiv). 1999; 41(4): 30-7.
  • Roth JA, Chrobak C, Schädelin S, Hug BL. MELD score as a predictor of mortality, length of hospital stay, and disease burden: A single-center retrospective study in 39,323 inpatients. Medicine (Baltimore). 2017; 96(24): 7155.
  • Şengüldür E, Aksoy İ, Katı C, Yardan T, Baydın A. Mushroom Poisoning Imitating Stroke. Report of a Case and Review of the Literature. Van Tıp Derg 2018; 25(3): 427-29.
  • Enjalbert F, Rapior S, Nouguier-Soule J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol. 2002; 40(6): 715-57.
  • Unluoglu I, Tayfur M. Mushroom poisoning: an analysis of the data between 1996 and 2000. Eur J Emerg Med. 2003; 10(1): 23-6.
  • Eren SH, Demirel Y, Ugurlu S, Korkmaz I, Aktas C, Güven FM. Mushroom poisoning: retrospective analysis of 294 cases. Clinics (Sao Paulo). 2010; 65(5): 491-6.

Mantar Zehirlenmesiyle Acil Servise Başvuran Hastaların Karakteristik Özellikleri ve Laboratuvar Parametrelerinin Prognoz Tayininde Rolü

Year 2023, Volume: 13 Issue: 3, 337 - 345, 21.09.2023
https://doi.org/10.33631/sabd.1292429

Abstract

Amaç: Bu çalışmada acil servise mantar yeme sonrası gelişen zehirlenme tablosu ile başvuran hastaların genel karakteristiklerinin araştırılması ve olası prognostic faktörlerin belirlenmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu çalışma Samsun, Türkiye’deki bir üniversite hastanesi acil servisine 6 yıl içerisinde mantar zehirlenmesi ile başvuran 18 yaş ve üzerindeki hastaların kayıtlarının geriye dönük olarak incelenmesi ile yapıldı. Çalışmada mortalite öngördürücü ve zehirlenme ciddiyetini gösteren modeller kullanılarak hastalar gruplandırıldı. Son dönem karaciğer hastalığı için model (MELD) skorlaması ve zehirlenme şiddet skoru (PSS) bu amaçla kullanıldı. Bu çalışmaya ait elde edilen tüm veriler Statistical Package for Social Sciences (SPSS) for Windows 15.0 paket programı kullanılarak analiz edildi.
Bulgular: Mantar zehirlenmesi ile acil servise başvuran 471 hastadan 16 tanesinde karaciğer yetmezliği geliştiği saptandı. Karaciğer yetmezliği gelişmeyen 455 hastada semptom başlangıç süresinin ortalama 2 saat olduğu, karaciğer yetmezliği gelişen 16 hastada ise semptom başlangıç süresinin ortalama 9,5 saat olduğu saptandı. Mantar zehirlenmeli hastalar PSS’sine göre sınıflandırıldığında, hastalarımızın %91,1’i PSS 1 olarak acil servise başvurmuş iken, %2,1’i ise şiddetli semptomlarla acil servise başvurmuştu. Mantar zehirlenmesiyle gelen hastaların %93,6’sı MELD skoru hafif olan hastalardı.
Sonuç: Mantar intoksikasyonu olgularında en sık klinik bulgu bulantı ve kusmadır. Mantar intoksikasyonu hastalarında semptomların 2 saat içerisinde ortaya çıkması iyi prognoz göstergesidir. MELD skoruna göre Bun değeri yükseldikçe hastalık ciddiyeti de artmaktadır. Aynı zamanda BUN ve amilaz değeri yüksekliği PSS’ye göre hayatı tehdit edici bir zehirlenme açısından hekimi uyarıcı roldedir.

References

  • Gold JAW, Kiernan E, Yeh M, Jackson BR, Benedict K. Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions - United States, 2016-2018. MMWR Morb Mortal Wkly Rep. 2021; 70(10): 337-41.
  • Brandenburg WE, Ward KJ. Mushroom poisoning epidemiology in the United States. Mycologia. 2018: 110(4); 637-41.
  • Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005; 33(2): 427-36.
  • Yu JW, Wang GQ, Li SC. Prediction of the prognosis in patients with acute-on-chronic hepatitis using the MELD scoring system. J Gastroenterol Hepatol. 2006; 21(10): 1519-24.
  • Persson HE, Sjöberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol. 1998; 36(3): 205-13.
  • Kakisaka K, Kataoka K, Onodera M, Suzuki A, Endo K, Tatemichi Y, at al. Alpha-fetoprotein: A biomarker for the recruitment of progenitor cells in the liver in patients with acute liver injury or failure. Hepatol Res. 2015; 45(10): 12-20.
  • Yardan T, Baydin A, Eden AO, Akdemir HU, Aygun D, Acar E, et al. Wild mushroom poisonings in the Middle Black Sea region in Turkey: analyses of 6 years. Hum Exp Toxicol. 2010; 29(9): 767-71.
  • Hocaoglu N, Kalkan Ş, Tunçok Y. Mushroom poisonings reported to the Dokuz Eylul University drug and poison information center. Turk J Emerg Med 2010; 10(3): 119-25.
  • Erdur B, Türkçüer İ, Ergin A, Canbora PT, Bozkır M. Assessment of mushroom poisoning cases in Denizli in 2006. Turk J Emerg Med 2007; 7(3): 109-14.
  • Cassidy N, Duggan E, Tracey JA. Mushroom poisoning in Ireland: the collaboration between the national poisons information centre and expert mycologists. Clin Toxicol (Phila). 2011; 49(3): 171-6.
  • Badsar A, Taramsari MR, Amir Maafi A, Rad MR, Chatrnour G, Jahromi SK. Mushroom poisoning in the southwest region of the caspian sea, Iran: a retrospective study. Iranian Journal of Toxicology 2013; 7(20): 798-803.
  • Sönmez E, Karakuş A, Çavuş UY, Civelek C, İpek G, Zeren C. Evaluation of intoxication cases admitted to emergency department of a university hospital. Dicle Tıp Derg. 2012; 39(1): 21-6.
  • Çevik AA, Ünlüoğlu İ, Ergün N, Şahin A. Poisoning severity scores of cases with mushroom poisoning presenting to the emergency department. Turk Journal Emergency Medical. 2007; 7(3): 102-8.
  • Goldfrank L. Goldfrank’s toxicologic emergencys 9th edition. Mc Graw Hill 2011.
  • Garcia J, Costa VM, Carvalho A, Baptista P, de Pinho PG, de Lourdes Bastos M, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. 2015; 86: 41-55.
  • Karvellas CJ, Tillman H, Leung AA, Lee WM, Schilsky ML, Hameed B, et al. Acute liver injury and acute liver failure from mushroom poisoning in North America. Liver Int. 2016; 36(7): 1043-50.
  • Iliev Y, Andonova S, Akabaliev V. Our experience in the treatment of acute Amanita phalloides poisoning. Folia Med (Plovdiv). 1999; 41(4): 30-7.
  • Roth JA, Chrobak C, Schädelin S, Hug BL. MELD score as a predictor of mortality, length of hospital stay, and disease burden: A single-center retrospective study in 39,323 inpatients. Medicine (Baltimore). 2017; 96(24): 7155.
  • Şengüldür E, Aksoy İ, Katı C, Yardan T, Baydın A. Mushroom Poisoning Imitating Stroke. Report of a Case and Review of the Literature. Van Tıp Derg 2018; 25(3): 427-29.
  • Enjalbert F, Rapior S, Nouguier-Soule J, Guillon S, Amouroux N, Cabot C. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol. 2002; 40(6): 715-57.
  • Unluoglu I, Tayfur M. Mushroom poisoning: an analysis of the data between 1996 and 2000. Eur J Emerg Med. 2003; 10(1): 23-6.
  • Eren SH, Demirel Y, Ugurlu S, Korkmaz I, Aktas C, Güven FM. Mushroom poisoning: retrospective analysis of 294 cases. Clinics (Sao Paulo). 2010; 65(5): 491-6.
There are 22 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Erdinç Şengüldür 0000-0002-3978-9534

Mehmet Cihat Demir 0000-0002-0106-3383

Ahmet Baydın 0000-0003-4987-0878

Publication Date September 21, 2023
Submission Date May 4, 2023
Published in Issue Year 2023 Volume: 13 Issue: 3

Cite

Vancouver Şengüldür E, Demir MC, Baydın A. Characteristics of Patients Presenting to the Emergency Department with Mushroom Poisoning and the Role of Laboratory Parameters in Determining Prognosis. VHS. 2023;13(3):337-45.