New Treatment in Mushroom Poisoning

On January 2 they came to the Dominican Hospital Emergency Department complaining of nausea, vomiting and diarrhea. Samples of four of the six species were available and identified by FFSC member Mark Gillespie as Lyophyllum decastes, Russula brevipes, Russula chamaeleontina and Lactarius alnicola. Only the L. alnicola is considered inedible due to its acrid latex. Based on liver enzyme levels, it was presumed that one of the other two mushrooms consumed was Amanita phalloides. Treatment for amatoxins in the US is generally supportive, as there is no known antidote. The end result can be a liver transplant (see An Amanita Poisoning Account) or death, though some come through with liver intact.

But a very different path was taken in this case. Dr. Todd Mitchell, hospitalist at Dominican Santa Cruz Hospital, was caring for the family. In researching mushroom poisoning, he came across references to treatment with milk thistle extract for liver damage. Intravenous silymarin extract has been used in Germany with promising results for treatment of mushroom poisoning. This is often discussed in mycological circles but apparently not widely disseminated in the medical community. Indeed, it had never been used in the US for this purpose.

Drs. Todd Mitchell and Wendy Knapp made extraordinary efforts to contact the manufacturer in Belgium, obtain protocols for use, solicit emergency FDA approval as an investigative drug (without which shipment was illegal and impossible) and rush the drug, Legalon-Sil, to California. All of this happened extremely quickly, as time was critical. (For a detailed, suspenseful account, BAMS has reprinted a Santa Cruz Sentinel article about the incident, written by Jondi Gumz.)

In the meantime, Bio-Silymarin milk thistle extract capsules from Aloha Medicinals here in Santa Cruz were administered to the patients. Five of the six were then transferred to California Pacific Medical Center in San Francisco, which has a large liver transplant program and greater capacity to care for such a large influx of patients. They agreed to utilize the Legalon-Sil according to the new protocol to treat the two most gravely ill patients, the 83 year old grandmother and the 29 year old man. The grandmother, due to her advanced age, was not a good transplant candidate. The young man seemed destined for a transplant. The other family members recovered and were discharged. Sadly, the grandmother died as a result of the mushroom poisoning. Her liver was recovering and then her kidneys failed. The 29 year old, however, recovered without transplant.

Was it because of the silymarin? Unknown. But the significant development is that now this potential treatment can be utilized here, and data collected and evaluated.

“We’re going to work closely with the Poison Control Center, Madaus (the manufacturer) and the FDA to allow us to maintain a supply of this medicine in Northern California so it’s available to be used within 12-24 hours,” Mitchell said.

In conclusion, Drs. Mitchell and Knapp, Dominican Hospital and California Pacific Medical Center are to be commended for taking bold steps not taken elsewhere in this country.

Common names: St. Mary's Thistle, holy thistle. Sometimes called silymarin, after the Latin name Silybum marianum.

History: Native to the Mediterranean. Used for thousands of years as a remedy for ailments, especially liver problems. Typically used to treat liver cirrhosis, chronic hepatitis and gallbladder disorders.

How it is used: Silymarin can be extracted from the seeds, believed to be the biologically active part.

Important:

• Eating milk thistle or taking a milk thistle supplement is not a cure for mushroom toxicity. Silymarin is a highly purified, intravenously administered extract.

• If you believe you or someone you know may be experiencing mushroom poisoning or an adverse reaction to eating a mushroom, call 911. To learn more, see Mushroom Poisoning.