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Calf strain — MRCEM SBA MCQ

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HardSoft Tissue InjuryCalf strainMRCEM SBA

A family develops profuse vomiting and diarrhoea 10 hours after eating foraged mushrooms. Symptoms transiently improve, but one patient then develops rising INR, hypoglycaemia and transaminases. Which escalation is most appropriate?

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Correct answer: D — Give silibinin and obtain urgent liver-transplant-centre advice

The best answer is “Give silibinin and obtain urgent liver-transplant-centre advice”. The delayed gastrointestinal phase followed by apparent recovery and then acute hepatic failure is characteristic of amatoxin poisoning, commonly from Amanita phalloides. The symptom-free interval is deceptive. Early repeated charcoal may reduce enterohepatic recirculation when advised, silibinin is used where available, and N-acetylcysteine is commonly added as supportive therapy. No single antidote makes monitoring unnecessary. Rapid toxicology and transplant-centre involvement is crucial because INR, lactate, hypoglycaemia, encephalopathy and renal injury can deteriorate rapidly and determine transplantation need.

Reference: Amanita phalloides poisoning: mechanisms and treatment: https://pmc.ncbi.nlm.nih.gov/articles/PMC11640968/