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Amanita Phalloides Poisoning — RACP Adult Medicine MCQ

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HardEmergency MedicineAmanita Phalloides PoisoningRACP Adult Medicine

A 40-year-old man presents with acute liver failure (INR 4.5, bilirubin 350 µmol/L, hepatic encephalopathy grade III). He took a large quantity of Amanita phalloides (death cap) mushrooms 3 days ago. What is the critical treatment?

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Correct answer: B — N-acetylcysteine and urgent liver transplant assessment

Amanita phalloides poisoning causes severe hepatotoxicity via amatoxin-mediated inhibition of RNA polymerase II. Acute liver failure develops 3–5 days post-ingestion. Management includes IV N-acetylcysteine (hepatoprotective), high-dose IV penicillin G or silibinin (to block hepatocyte amatoxin uptake), and urgent liver transplant assessment (mortality without transplant in severe cases is >50%). King's College criteria guide transplant decision-making. This is a notifiable poisoning in some Australian states.

Reference: eTG – 2025 – Toxicology; Austin Health – 2024 – Mushroom Poisoning Protocol