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J Korean Soc Emerg Med > Volume 11(2); 2000 > Article
Journal of The Korean Society of Emergency Medicine 2000;11(2): 224-230.
Clinical Analysis of Phalloides Syndrome
Kyu Seok Kim, Young Woon Lim, Joong Sik Jung, Sang Do Sin, Chang Hae Pyo, Joong Eui Rhee, Gil Joon Suh, Sung Eun Jung, Yeo Kyu Youn, Jeong Bae Park, Kang Suk Seo, Eun Young Rue, Yong Su Lim
1Department of Emergency Medicine, Seoul National University Hospital, Korea. threeeinsteins@yahoo.co.kr
2Department of Microbiology, Seoul National University, Korea.
3Department of Emergency, School of Medicine, Kyungpook National University, Korea.
4Department of Emergency Medicine, Uijongbu St. Mary 's Hospital The Catholic University of Korea, Korea.
5Department of Emergency Medicine, Gachon Medical College, Korea.
BACKGROUND: To review the important features and treatment modalities of phalloides syndrome. METHOD: We performed a retrospective analysis of 16 patients with phalloides syndrome who visited the Emergency Center of Seoul National University ospital, Uijongbu St. Mary 's Hospital, Gachon Medical College Hospital, and Kyungpook National University Hospital from July 1st to August 31st, 1998. Mann-Whitney U test was used for statistical analysis(p < 0.05).
9 were male and 7 were female. The mean age was 54 years(men 46 years, women 65 years). Fourteen cases(88%) occurred in Kyungpook area. All cases of phalloides syndrome RESULT:ed from mistaking toxic mushrooms for edible mushrooms. The doses of ingestion of mushroom were not available because the patient could not remember the exact amounts. The identification of mushrooms in 4 cases was confirmed by mycologist, 6 cases by mushroom photoatlas, and remained 6 cases were not confirmed. The initial symptoms of mushroom poisoning were abdominal pain, nausea, and watery diarrhea. The time intervals from the ingestion of mushroom to the onset of symptom were from 6 to 13 hours(mean 11.3 +/-2.68 hours). The laboratory data showed the increased GOT and GPT, prolonged prothrombin time, elevated serum creatinine level, and decreased platelet count. The initial management of phalloides mushroom poisoning was done conservatively, but the early specific treatments such as gastrointestinal decontamination, administration of activated charcoal, IV penicillin or silymarin were not perfomed in all cases. The mortality rate was 18.8%. There were significant differences in total bilirubin, prothrombin time, platelet count, and serum creatinine between survival and non-survival group(p<0.05).
It is important to know the morphological differences between edible and toxic mushroom for prevention of phalloides syndrome. If the patient with acute gastroenteritis has a history of mushroom ingestion, the emergency physician should suspect phalloides syndrome and start early proper treatment. For the identification of mushroom, it is desirable to contact a mycologist.
Key words: Phalloides syndrome, Mushroom
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