Amatoxin (death cap) mushroom poisoning

Severe acute poisoning by death cap amatoxins. Severe gastroenteritis develops 6–24 hours after ingestion, followed by fulminant liver failure. Mortality without specific therapy reaches 20–30%. Treatment includes IV silibinin, NAC, supportive care and liver transplant if needed.

ICD-10 T62.01 drug

Also known as: Amanita phalloides poisoning, Amatoxin hepatitis, Death cap intoxication

Drugs used for this condition

BSilymarin (Silybum marianum)First line · Plant antioxidant from milk thistle fruits; IV silibinin is an antidote in Amanita phalloides poisoningIntravenous silibinin (Legalon SIL) is part of the standard protocol for confirmed Amanita phalloides poisoning. Dose: 5 mg/kg over 1 hour, then 20 mg/kg/day continuous infusion for 3–5 days. The drug blocks α-amanitin uptake by hepatocytes and reduces mortality. SEIMC 2022 and Spanish toxicology centres recommend «IV silibinin + NAC + supportive care + early contact with a transplant centre». Oral milk thistle capsules do not work in acute poisoning – the IV formulation in hospital is required.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit