Ghiringhelli L, Ceriani A, Lepore G, Moda S
Minerva Med. 1981 Sep 29;72(37):2499-508.
28 cases of phallinic syndrome have been studied: 24 out of them were from amanita phalloides poisoning and 4 from amanita verna poisoning. After a lag phase lasting from 7 to 30 hours, symptomatology characterized by starting gastroenteric troubles as vomit, diarrhea, abdominal cramps, meteorism and pain following abdomen palpation. In one case the syndrome started with parasympathicomimetic crisis, probabily due to ingested amanita containing muscarinic type poison. Subsequent evolution of clinical picture included signs of hepatic and renal involvement. As far as laboratory diagnosis is concerned, high levels of serum aminotransferases were found and, less frequently, hyperbilirubinmia and high BUN levels occurred. In severe cases, in addition, lowered values for plasma prothrombine, fibrinogen and cholinesterase were found. Low therapeutic effect followed rehydration, equilibration of electrolytic unbalance and administration of thioctic acid, coagulants and so on. As a matter of fact 3 out or 28 patients, treated only with such therapy, died. On the contrary good therapeutic effect followed to peritoneal dialysis, in two cases coupled to exchange transfusion: 10 patients were treated in such a way and no one died but all of them quickly recovered. Forced diuresis also appeared greatly useful and practical in therapeutic treatment of phallinic syndrome: results compared favourably with those obtained by means of peritoneal dialysis. As a matter of fact 15 patients, 5 of them having ingested a great amount of amanita phalloides, were treated with forced diuresis and no one of them died. Finally, the need is stressed for a very quick therapeutic intervention (exchange transfusion; plasmapheresis; peritoneal dialysis; forced diuresis, and so on) in order to lower the plasma concentration of the toxins responsible for the phallinic syndrome. Only in such a way diffusion of toxins from blood to tissues is avoided.
对28例毒伞菌中毒综合征病例进行了研究：其中24例由毒鹅膏中毒引起，4例由春生鹅膏中毒引起。经过7至30小时的潜伏期后，症状表现为开始出现胃肠道问题，如呕吐、腹泻、腹部绞痛、腹胀和腹部触诊疼痛。有1例综合征以拟副交感神经危象开始，可能是由于摄入了含有毒蕈碱型毒素的鹅膏菌。临床症状的后续演变包括肝脏和肾脏受累的迹象。就实验室诊断而言，发现血清转氨酶水平升高，较少见的是高胆红素血症和高尿素氮水平。在严重病例中，还发现血浆凝血酶原、纤维蛋白原和胆碱酯酶值降低。补液、纠正电解质失衡以及给予硫辛酸、凝血剂等治疗效果不佳。事实上，仅采用这种治疗方法的28例患者中有3例死亡。相反，腹膜透析取得了良好的治疗效果，有2例同时进行了换血治疗：10例患者采用这种方法治疗，无一例死亡，全部迅速康复。强制利尿在毒伞菌中毒综合征的治疗中也显得非常有用和实用：其结果与通过腹膜透析获得的结果相比更有利。事实上，15例患者，其中5例摄入了大量毒鹅膏，接受了强制利尿治疗，无一例死亡。最后，强调需要非常迅速地进行治疗干预（换血；血浆置换；腹膜透析；强制利尿等），以降低导致毒伞菌中毒综合征的毒素的血浆浓度。只有这样才能避免毒素从血液扩散到组织。
