Ingestion of amatoxin-containing mushrooms — most notably Amanita species — can cause severe, rapid-onset acute liver failure. Management is time-critical: intervention must begin as early as possible after ingestion to limit toxin absorption and prevent irreversible hepatic injury.
This protocol addresses ALF arising specifically from amatoxin/Amanita mushroom poisoning. The approach combines prompt gastrointestinal decontamination to reduce toxin absorption with targeted intravenous antidotal therapy that should be initiated without delay.
Early GI decontamination is a cornerstone of initial management. This is followed by sustained IV hydration to support toxin elimination, and specific IV antidotal therapy — with an alternative agent available if the primary option cannot be obtained. The complete protocol defines agent selection, sequencing, and the monitoring criteria that guide duration of therapy.
DOI: 10.14309/ajg.0000000000002340