Activated charcoal
Some advocate repeated doses during the first 24hr
Amatoxin undergoes enterohepatic circulation
Penicillin
High doses 1 mil units/kg/d effective in animal studies (inhibits amatoxin uptake)
Silibinin (milk thistle derivative)
Mortality benefit
Free radical scavenger used successfully in Europe
5mg/kg over 1 hr, then 25-50mg/kg/d
N-acetylcysteine admin much like in acetaminophen toxicity
Mortality benefit
Load 150mg/kg IV over 15min in 200 cc D5W
Then 50mg/kg in 500cc D5W over 4hrs
Followed by 100mg/kg in 1000cc D5W over 16hrs
Extracorporeal albumin dialysis
Allow hepatic regeneration or forestall transplantation
Some advocate repeated doses during the first 24hr
Amatoxin undergoes enterohepatic circulation
Amatoxin undergoes enterohepatic circulation
High doses 1 mil units/kg/d effective in animal studies (inhibits amatoxin uptake)
Mortality benefit
Free radical scavenger used successfully in Europe
5mg/kg over 1 hr, then 25-50mg/kg/d
Mortality benefit
Load 150mg/kg IV over 15min in 200 cc D5W
Then 50mg/kg in 500cc D5W over 4hrs
Followed by 100mg/kg in 1000cc D5W over 16hrs
Allow hepatic regeneration or forestall transplantation
Glucose monitoring
Hypoglycemia is one of the most common causes of death in early mushroom toxicity
Liver/renal failure monitoring
Serial LFTs, chem, coags
Prepare for liver transplant
Progressive coagulopathy, encephalopathy, renal failure are indications for transplant
Hypoglycemia is one of the most common causes of death in early mushroom toxicity
Serial LFTs, chem, coags
Progressive coagulopathy, encephalopathy, renal failure are indications for transplant
Amanita mushrooms
Acetaminophen toxicity 
Crotinarius mushrooms
Viral hepatitis
Gyromitra mushrooms
Hepatitis A
Jimson weed
Hepatitis B