Trakulsrichai Satariya, Jeeratheepatanont Peerawich, Sriapha Charuwan, Tongpoo Achara, Wananukul Winai
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Ramathibodi Poison Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Int J Gen Med. 2020 Nov 17;13:1139-1146. doi: 10.2147/IJGM.S271914. eCollection 2020.
To describe the clinical characteristics and outcomes of myotoxic mushroom poisoning in Thailand.
We performed a retrospective cohort study of cases of myotoxic mushroom poisoning from the Ramathibodi Poison Center Toxic Exposure Surveillance System during a 5-year period (2012-2016).
Forty-one cases were included. Most (53.7%) were male with the average age of 49 years. In three cases, the mushrooms were identified as species by an experienced mycologist. Common presenting symptoms were gastrointestinal (GI) symptoms and myalgia. The median onset of GI symptoms and symptoms suggesting rhabdomyolysis after consuming mushrooms was 2 hours (0.17-24 hours) and 24-48 hours (2-120 hours), respectively. Eight patients who ate the mushrooms together with other patients with rhabdomyolysis had GI symptoms but did not develop rhabdomyolysis. For patients with rhabdomyolysis, acute kidney injury (AKI) and hyperkalaemia occurred in 51.5% and 33.3% of cases, respectively. Median initial and maximum creatine phosphokinase (CPK) levels in patients with rhabdomyolysis were 31,145 and 47,861 U/L, respectively. Fifteen of 17 patients who were investigated for troponin levels had elevated troponin. Three patients had a low ejection fraction. Most patients (95.1%) were admitted to hospital, with a median stay of 5 days. The mortality rate was 26.8%. Treatments included intravenous fluid, urine alkalinization, haemodialysis and peritoneal dialysis. Among patients with rhabdomyolysis, AKI, hyperkalaemia during hospitalisation, maximum CPK level, maximum creatinine level and initial and maximum potassium levels were the factors found to be significantly different between patients who died and those who survived.
Myotoxic mushroom poisoning had a high mortality rate. Most patients had early or delayed onset of clinical symptoms after mushroom ingestion. Some patients developed severe cardiovascular effects. Early detection, close monitoring (especially serum potassium, creatinine, CPK and cardiac effect) and good supportive care were the main treatment modalities.
描述泰国肌毒性蘑菇中毒的临床特征及预后。
我们对拉玛蒂博迪中毒中心毒物暴露监测系统在5年期间（2012 - 2016年）的肌毒性蘑菇中毒病例进行了一项回顾性队列研究。
共纳入41例病例。大多数（53.7%）为男性，平均年龄49岁。3例病例中的蘑菇经经验丰富的真菌学家鉴定为某种物种。常见的首发症状为胃肠道（GI）症状和肌痛。食用蘑菇后出现胃肠道症状和提示横纹肌溶解症状的中位发病时间分别为2小时（0.17 - 24小时）和24 - 48小时（2 - 120小时）。8名与其他横纹肌溶解患者一起食用蘑菇的患者出现了胃肠道症状，但未发生横纹肌溶解。对于横纹肌溶解患者，急性肾损伤（AKI）和高钾血症分别发生在51.5%和33.3%的病例中。横纹肌溶解患者的肌酸磷酸激酶（CPK）初始和最高水平中位数分别为31,145和47,861 U/L。17例接受肌钙蛋白水平检测的患者中有15例肌钙蛋白升高。3例患者射血分数降低。大多数患者（95.1%）入院治疗，中位住院时间为5天。死亡率为26.8%。治疗包括静脉输液、尿液碱化、血液透析和腹膜透析。在横纹肌溶解患者中，死亡患者与存活患者在住院期间的急性肾损伤、高钾血症、最高CPK水平、最高肌酐水平以及初始和最高钾水平方面存在显著差异。
肌毒性蘑菇中毒死亡率高。大多数患者在食用蘑菇后出现早期或延迟的临床症状。部分患者出现严重心血管效应。早期检测、密切监测（尤其是血清钾、肌酐、CPK和心脏效应）以及良好的支持治疗是主要治疗方式。
