Amanita smithiana mushroom ingestion

A case of delayed renal failure and literature review

Patrick L. West, Janet Lindgren, B (Zane) Horowitz

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Introduction: In the Pacific Northwest a new pattern of mushroom ingestion has emerged, attributed to Amanita smithiana, in which renal failure has been the predominant manifestation. Case Report: A 55-year-old male ate 3 raw wild mushrooms in a salad and had onset of severe nausea and vomiting within 6 hours. His vital signs were unremarkable. His labs were significant for a BUN of 14mg/dL (5.0 mmol/L), and a creatinine of 1.0 mg/dL (88umol/L), transaminases were elevated with an AST of 56 U/L (nl 9-40) and an ALT of 131 U/L (nl 14-72). Treatment was initiated with N-acetyl cysteine, penicillin, and milk thistle extract on the presumption that this was an amanitin-toxin containing mushroom. He developed acute renal failure that was not responsive to our treatment. Dialysis started on day 4 with a creatinine of 6.5 mg/dL, which peaked on day 7 at 10.2 mg/dL. We were able to obtain a positive mushroom identification by a mycologist as Amanita smithiana. The patient was discharged from the hospital for outpatient dialysis on day 10 and dialysis catheter was removed 39 days after ingestion with a creatinine of 1.4 mg/dL (123.8 umol/L). Discussion: Amanita smithiana mushroom poisoning presents within 6 hours of ingestion with GI toxicity, and develops delayed onset of renal insufficiency over the first 1 to 4 days. The early hospitalization of this case allowed a profile of the onset of liver and renal injury. Mild elevation of hepatic transaminases occurred on presentation and peaked 24 hours after the ingestion. Renal injury was detected 1 day after presentation, and progressed to require hemodialysis by 4 days postingestion. This pattern of delayed-onset renal toxic mushroom ingestion is emerging among mushroom ingestions in Western North America.

Original languageEnglish (US)
Pages (from-to)32-38
Number of pages7
JournalJournal of Medical Toxicology
Volume5
Issue number1
DOIs
StatePublished - 2009

Fingerprint

Amanita
Dialysis
Agaricales
Renal Insufficiency
Creatinine
Eating
Transaminases
Acetylcysteine
Amanitins
Catheters
Poisons
Kidney
Penicillins
Liver
Toxicity
Mushroom Poisoning
Milk Thistle
Northwestern United States
Vital Signs
Blood Urea Nitrogen

Keywords

  • Amanita smithiana
  • Dialysis
  • Mushroom ingestion
  • Renal failure

ASJC Scopus subject areas

  • Health, Toxicology and Mutagenesis
  • Toxicology

Cite this

Amanita smithiana mushroom ingestion : A case of delayed renal failure and literature review. / West, Patrick L.; Lindgren, Janet; Horowitz, B (Zane).

In: Journal of Medical Toxicology, Vol. 5, No. 1, 2009, p. 32-38.

Research output: Contribution to journalArticle

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