Death Cap Mushroom ALF — RACP Adult Medicine MCQ

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HardGastroenterologyDeath Cap Mushroom ALFRACP Adult Medicine

A 20-year-old man with ALF from Amanita phalloides (death cap mushroom) ingestion presents 48 hours after ingestion with liver failure (ALT 8000, INR 6.0, encephalopathy). He ate wild mushrooms 2 days ago. What is the specific antidote?

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Correct answer: A — Silibinin (milk thistle extract)

Amanita phalloides (death cap mushroom) poisoning causes delayed hepatotoxicity (onset 6-24 hours after ingestion — latent period creates a deceptive early well period). Toxins: amatoxin (inhibits RNA polymerase II). Specific treatment: IV silibinin (silymarin/milk thistle extract — interrupts enterohepatic recirculation of amatoxin and protects hepatocytes) + high-dose IV penicillin G (displaces amatoxin from albumin). NAC is also given. Activated charcoal if within 4 hours. Liver transplant for fulminant cases.

Reference: Toxicology Handbook (Murray); eTG 2024 – Mushroom Poisoning