• 1.

    Puschner B, Wegenast C. Mushroom poisoning cases in dogs and cats: diagnosis and treatment of hepatotoxic, neurotoxic, gastroenterotoxic, nephrotoxic, and muscarinic mushrooms. Vet Clin North Am Small Anim Pract 2018;48:10531067.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Puschner B, Rose HH, Filigenzi MS. Diagnosis of Amanita toxicosis in a dog with acute hepatic necrosis. J Vet Diagn Invest 2007;19:312317.

  • 3.

    Tegzes JH, Puschner B. Amanita mushroom poisoning: efficacy of aggressive treatment of two dogs. Vet Hum Toxicol 2002;44:9699.

  • 4.

    Tokarz D, Poppenga R, Kaae J, et al. Amanitin toxicosis in two cats with acute hepatic and renal failure. Vet Pathol 2012;49:10321035.

  • 5.

    Yee MM, Woods LW, Poppenga RH, et al. Amanitin intoxication in two beef calves in California. J Vet Diagn Invest 2012;24:241244.

  • 6.

    Garcia J, Costa VM, Carvalho A, et al. Amanita phalloides poisoning: mechanisms of toxicity and treatment. Food Chem Toxicol 2015;86:4155.

  • 7.

    Enjalbert F, Rapior S, Nouguier-Soule J, et al. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol 2002;40:715757.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Vo KT, Montgomery M, Mitchell T, et al. Amanita phalloides mushroom poisonings – Northern California, December 2016. MMWR Morb Mortal Wkly Rep 2017;66:549553.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Ammirati JF, Thiers HD, Horgen PA. Amatoxin-containing mushrooms: Amanita ocreata and A. phalloides in California. Mycologia 1977;69:10951108.

  • 10.

    Olson KR, Pond SM, Seward J, et al. Amanita phalloides-type mushroom poisoning. West J Med 1982;137:282289.

  • 11.

    Goldfrank LR. Mushrooms. In: Hoffman RS, Howland MA, Lewin NA, et al., eds. Goldfrank's toxicologic emergencies. 10th ed. New York: McGraw-Hill Education, 2015;15001514.

    • Search Google Scholar
    • Export Citation
  • 12.

    Faulstich H, Fauser U. The course of Amanita intoxication in Beagle dogs. In: Faulstich H, Kommerell B, Wieland T, eds. Amanita toxins and poisoning: International Amanita Symposium Heidelberg, November 1–3, 1978. Baden-Baden, Germany: Witzstrock, 1980;115120.

    • Search Google Scholar
    • Export Citation
  • 13.

    Letschert K, Faulstich H, Keller D, et al. Molecular characterization and inhibition of amanitin uptake into human hepatocytes. Toxicol Sci 2006;91:140149.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Jaeger A, Jehl F, Flesch F, et al. Kinetics of amatoxins in human poisoning: therapeutic implications. J Toxicol Clin Toxicol 1993;31:6380.

  • 15.

    Faulstich H, Talas A, Wellhöner HH. Toxicokinetics of labeled amatoxins in the dog. Arch Toxicol 1985;56:190194.

  • 16.

    Puschner B. Mushrooms. In: Peterson ME, Talcott PA, eds. Small animal toxicology. 3rd ed. St Louis: Elsevier Saunders, 2013;659676.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Filigenzi MS, Poppenga RH, Tiwary AK, et al. Determination of alpha-amanitin in serum and liver by multistage linear ion trap mass spectrometry. J Agric Food Chem 2007;55:27842790.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Sellon RK. Acetaminophen. In: Peterson ME, Talcott PA, eds. Small animal toxicology. 3rd ed. St Louis: Elsevier Saunders, 2013;423429.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Romano MC, Doan HK, Poppenga RH, et al. Fatal Amanita muscaria poisoning in a dog confirmed by PCR identification of mushrooms. J Vet Diagn Invest 2019;31:485487.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Bever CS, Swanson KD, Hamelin EI, et al. Rapid, sensitive, and accurate point-of-care detection of lethal amatoxins in urine. Toxins (Basel) 2020;12:123.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Sun J, Niu YM, Zhang YT, et al. Toxicity and toxicokinetics of Amanita exitialis in Beagle dogs. Toxicon 2018;143:5967.

  • 22.

    Kawaji A, Yamauchi K, Fujii S, et al. Effects of mushroom toxins on glycogenolysis; comparison of toxicity of phalloidin, alpha-amanitin and DL-propargylglycine in isolated rat hepatocytes. J Pharmacobiodyn 1992;15:107112.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    De Carlo E, Milanesi A, Martini C, et al. Effects of Amanita phalloides toxins on insulin release: in vivo and in vitro studies. Arch Toxicol 2003;77:441445.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Karvellas CJ, Tillman H, Leung AA, et al. Acute liver injury and acute liver failure from mushroom poisoning in North America. Liver Int 2016;36:10431050.

  • 25.

    Thiel C, Thiel K, Klingert W, et al. The enterohepatic circulation of amanitin: kinetics and therapeutical implications. Toxicol Lett 2011;203:142146.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Sun J, Zhang YT, Niu YM, et al. Effect of biliary drainage on the toxicity and toxicokinetics of Amanita exitialis in Beagles. Toxins (Basel) 2018;10:215.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Mullins ME, Horowitz BZ. The futility of hemoperfusion and hemodialysis in Amanita phalloides poisoning. Vet Hum Toxicol 2000;42:9091.

    • Search Google Scholar
    • Export Citation
  • 28.

    Bernal W, Wendon J. Acute liver failure. N Engl J Med 2013;369:25252534.

  • 29.

    Vogel G, Tuchweber B, Trost W, et al. Protection by silibinin against Amanita phalloides intoxication in Beagles. Toxicol Appl Pharmacol 1984;73:355362.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Floersheim GL, Eberhard M, Tschumi P, et al. Effects of penicillin and silymarin on liver enzymes and blood clotting factors in dogs given a boiled preparation of Amanita phalloides. Toxicol Appl Pharmacol 1978;46:455462.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Kidd P, Head K. A review of the bioavailability and clinical efficacy of milk thistle phytosome: a silybin-phosphatidylcholine complex (Siliphos). Altern Med Rev 2005;10:193203.

    • Search Google Scholar
    • Export Citation
  • 32.

    Filburn CR, Kettenacker R, Griffin DW. Bioavailability of a silybin-phosphatidylcholine complex in dogs. J Vet Pharmacol Ther 2007;30:132138.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Mengs U, Pohl RT, Mitchell T. Legalon SIL: the antidote of choice in patients with acute hepatotoxicity from amatoxin poisoning. Curr Pharm Biotechnol 2012;13:19641970.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Hruby K, Csomos G, Fuhrmann M, et al. Chemotherapy of Amanita phalloides poisoning with intravenous silibinin. Hum Toxicol 1983;2:183195.

  • 35.

    Bonacini M, Shetler K, Yu I, et al. Features of patients with severe hepatitis due to mushroom poisoning and factors associated with outcome. Clin Gastroenterol Hepatol 2017;15:776779.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement

Physical examination, serum biochemical, and coagulation abnormalities, treatments, and outcomes for dogs with toxicosis from α-amanitin–containing mushrooms: 59 cases (2006–2019)

Jennifer A. Kaae VMD1, Robert H. Poppenga DVM, PhD2, and Ashley E. Hill DVM, MPVM, PhD2
View More View Less
  • 1 Pet Emergency and Specialty Center of Marin, San Rafael, CA 94901.
  • | 2 California Animal Health and Food Safety Laboratory System, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

OBJECTIVE

To report history, physical examination findings, clinicopathologic abnormalities, treatments, and outcomes of dogs with confirmed α-amanitin toxicosis resulting from ingestion of α-amanitin–containing mushrooms, and to report whether any differences were significant between survivors and nonsurvivors.

ANIMALS

59 dogs.

PROCEDURES

Medical records of all dogs with confirmed α-amanitin toxicosis presented to a northern California emergency and specialty veterinary hospital between January 2006 and July 2019 were reviewed for signalment; body weight; history; physical examination findings including rectal temperature at presentation; results of serum biochemical analyses, coagulation tests, and a test for the detection of α-amanitin in urine; treatments; and outcomes. Differences for each were compared between survivors and nonsurvivors.

RESULTS

Among the 59 dogs, 36 were < 1 year of age; 56 had variable clinical signs that included vomiting, diarrhea, anorexia, and weakness or lethargy; and 22 had rectal temperatures > 39.2°C (102.5°F) at presentation. Cases were seen throughout the calendar year. At presentation, alanine aminotransferase activity was mildly to markedly increased in 97% of dogs, hypoglycemia was noted in 78%, and coagulation times were prolonged in 91%. Most dogs that rapidly decompensated died; however, 13 dogs survived to hospital discharge and completely recovered.

CONCLUSIONS AND CLINICAL RELEVANCE

Ability to recognize dogs with α-amanitin toxicosis on the basis of clinical signs, physical examination findings, and clinicopathologic test results is essential because mushroom ingestion is rarely observed and immediate treatment is necessary. Dogs that have marked hypoglycemia or coagulopathy may have a poor prognosis.

OBJECTIVE

To report history, physical examination findings, clinicopathologic abnormalities, treatments, and outcomes of dogs with confirmed α-amanitin toxicosis resulting from ingestion of α-amanitin–containing mushrooms, and to report whether any differences were significant between survivors and nonsurvivors.

ANIMALS

59 dogs.

PROCEDURES

Medical records of all dogs with confirmed α-amanitin toxicosis presented to a northern California emergency and specialty veterinary hospital between January 2006 and July 2019 were reviewed for signalment; body weight; history; physical examination findings including rectal temperature at presentation; results of serum biochemical analyses, coagulation tests, and a test for the detection of α-amanitin in urine; treatments; and outcomes. Differences for each were compared between survivors and nonsurvivors.

RESULTS

Among the 59 dogs, 36 were < 1 year of age; 56 had variable clinical signs that included vomiting, diarrhea, anorexia, and weakness or lethargy; and 22 had rectal temperatures > 39.2°C (102.5°F) at presentation. Cases were seen throughout the calendar year. At presentation, alanine aminotransferase activity was mildly to markedly increased in 97% of dogs, hypoglycemia was noted in 78%, and coagulation times were prolonged in 91%. Most dogs that rapidly decompensated died; however, 13 dogs survived to hospital discharge and completely recovered.

CONCLUSIONS AND CLINICAL RELEVANCE

Ability to recognize dogs with α-amanitin toxicosis on the basis of clinical signs, physical examination findings, and clinicopathologic test results is essential because mushroom ingestion is rarely observed and immediate treatment is necessary. Dogs that have marked hypoglycemia or coagulopathy may have a poor prognosis.

Contributor Notes

Address correspondence to Dr. Kaae (jkaae@ethosvet.com).