INTRODUCTION: Amanita phalloides poisoning is a potentially fatal cause of acute liver failure. The aim of this study was to analyze the impact of initial patients' characteristics and different treatment modalities on the outcome of patients with liver failure caused by Amanita poisoning. MATERIAL AND METHODS: We retrospectively evaluated 23 patients admitted to our center between July 2007 and August 2016. RESULTS: Mean time interval between Amanita phalloides ingestion and the onset of gastrointestinal symptoms was 12.48 ± 9.88 hours and the interval between ingestion and hospital admission 26.26 ± 15.14 hours. The treatment was intiated by oral decontamination using activated charcoal followed by intravenous rehydration and high doses of intravenous N-acetylcysteine and silibinin. Fourteen patients (61%) underwent extracorporeal elimination method. Ten patients had plasmapheresis, 1 patient had hemoperfusion, and 5 patients had fractionated plasma separation and adsorption. Seven patients who met King's College Criteria were listed for urgent liver transplantation; one of them died before transplantation. Six patients underwent liver transplantation; the mean waiting time was 6.5 ± 12.0 days (range, 1-31 days). One patient died 2 months afterward. All 16 patients who did not meet King's College Criteria and received conservative treatment survived. CONCLUSION: Our results documented a good prognostic value of standard King's College Criteria for indication of urgent liver transplantation in acute liver failure caused by Amanita phalloides poisoning. Fractionated plasma separation and adsorption may contribute to low mortality on the waiting list. Intensive care and extracorporeal elimination methods seem to be crucial points of the conservative treatment.
- MeSH
- Acetylcysteine administration & dosage MeSH
- Liver Failure, Acute etiology therapy MeSH
- Amanita MeSH
- Antidotes administration & dosage MeSH
- Antioxidants administration & dosage MeSH
- Renal Dialysis methods MeSH
- Adult MeSH
- Charcoal administration & dosage MeSH
- Hemoperfusion methods MeSH
- Conservative Treatment methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Mushroom Poisoning complications therapy MeSH
- Critical Care methods MeSH
- Plasmapheresis methods MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Waiting Lists mortality MeSH
- Silymarin administration & dosage MeSH
- Severity of Illness Index * MeSH
- Fluid Therapy methods MeSH
- Liver Transplantation methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Evaluation Study MeSH
BACKGROUND: Hyperchloremia produces renal vasoconstriction and fall in glomerular filtration rate. In 90% of brain-dead organ donors, diabetes insipidus develops, characterized by inappropriate diuresis, hyperosmolality, and hyperchloremia. The aim of this study was to determine the relationship between the serum concentration of chlorides of the donor and the onset of the function of the kidney allograft in the recipient. METHODS: We retrospectively studied 213 donors and kidney allograft recipients. Serum creatinine concentrations and glomerular filtration rates on the 1st, 7th, and 30th days after transplantation of the recipients from hyperchloremic donors were compared with the recipients from normochloremic donors, as well as the incidences of acute tubular necrosis and delayed graft function. RESULTS: On the 1st day, serum creatinine concentrations of the recipients from hyperchloremic and normochloremic donors, respectively, were 448.2 ± 212.1 μmol/L and 502.2 ± 197.8 μmol/L (P = .1), on the 7th day, 168.6 ± 102.6 μmol/L and 196.9 ± 120.6 μmol/L (P = .13), and on the 30th day, 129.4 ± 43.3 μmol/L and 131.8 ± 43.6 μmol/L (P = .73). The differences were statistically significant. The groups also did not differ significantly in glomerular filtration rates and incidences of acute tubular necrosis and delayed graft function. CONCLUSIONS: In this study, no significant correlation between serum chloride concentrations of the organ donors and the onset of the function of kidney allografts in the recipients was found.
- MeSH
- Acidosis complications physiopathology MeSH
- Kidney Tubular Necrosis, Acute blood epidemiology etiology MeSH
- Allografts physiopathology MeSH
- Chlorides blood physiology MeSH
- Tissue Donors * MeSH
- Adult MeSH
- Glomerular Filtration Rate MeSH
- Incidence MeSH
- Creatinine blood MeSH
- Kidney physiopathology MeSH
- Humans MeSH
- Brain Death physiopathology MeSH
- Delayed Graft Function blood epidemiology etiology MeSH
- Postoperative Complications blood epidemiology etiology MeSH
- Retrospective Studies MeSH
- Kidney Transplantation * MeSH
- Kidney Function Tests MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVE: The diagnosis of sepsis is difficult in immunocompromised patients owing to their modified response to infection. Our experiment in minipigs was designed to compare responses to sepsis between experimental groups of septic minipigs with and without immunosuppression. METHODS: Minipigs with identical baseline parameters were randomized into 3 groups: Sepsis (n = 10); immunosuppression (n = 11), including cyclosporine, methylprednisolone, and mycophenolate mofetil treatment before surgery, and a sham group (n = 6). Sepsis was induced by cecal ligation and puncture (CLP). We recorded selected clinical and laboratory parameters up to 24 hours postoperatively. RESULTS: All CLP animals developed septic shock with a febrile response, tachycardia, and hypotension requiring noradrenaline administration. The hemodynamic responses to sepsis in septic groups with and without immunosuppression were similar. Noradrenaline infusion was started on average later in the immunosuppression than in the group without immunosuppression; however, the difference was not significant. The kinetics of the plasma levels of most selected cytokines and C-reactive protein were similar in both septic groups. At 10 hours after surgery, the immunosuppression group showed significantly lower interleukin (IL)-6 levels compared with the sepsis group. At 19, 22, and 25 hours after surgery immunosuppressed animals displayed significantly greater increases in IL-10 levels compared with the cohort without immunosuppression. CONCLUSIONS: CLP is a simple, reproducible model of sepsis in minipigs. All CLP animals developed sepsis within 24 hours on average. Significant differences in IL-6 and IL-10 plasma levels were recorded between septic animals with versus without immunosuppression.
- MeSH
- Biomarkers blood MeSH
- Time Factors MeSH
- Cecum microbiology surgery MeSH
- Cyclosporine pharmacology MeSH
- Hemodynamics MeSH
- Immunocompromised Host * MeSH
- Immunosuppressive Agents pharmacology MeSH
- Cardiotonic Agents pharmacology MeSH
- Mycophenolic Acid analogs & derivatives MeSH
- Ligation MeSH
- Inflammation Mediators blood MeSH
- Methylprednisolone pharmacology MeSH
- Swine, Miniature MeSH
- Disease Models, Animal MeSH
- Norepinephrine pharmacology MeSH
- Swine MeSH
- Punctures MeSH
- Sepsis blood drug therapy immunology microbiology physiopathology MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
