From: Acute liver failure caused by Amanita verna: a case series and review of the literature
Patients | 1 | 2 | 3 |
---|---|---|---|
Gender | Male | Male | Female |
Age | 43 | 43 | 34 |
Time of admission | March 4, 2019 | March 4, 2019 | The patient was admitted to the hospital on March 9, 2019, and was transferred to Zhongshan hospital, Sun Yat-sen University after coma at about 11 am |
Cause of hospitalization | Nausea, vomiting and diarrhea occurred 18 h after eating wild mushrooms | Nausea, vomiting, and diarrhea occurred 18 h after eating wild mushrooms | Vomiting and diarrhea for 7 days, and vomiting for 1 day after eating mushrooms |
Previous medical history | Good health, no special problems | Good health, no special problems | Good health. The patient was pregnant twice with one child in the second trimester |
Mushroom intake | One bowl | Two bowls (about 20 Amanita) and a bowl of noodle soup (without Amanita) | Three bowls |
Four vital signs | T: 37.4 °C, P: 93 times/min, R: 20 times/min, BP: 139/57 mmHg | T: 36.8 °C, P: 75 times/min, R: 16 times/min, BP: 126/76 mmHg | T: 36.8 °C, P: 101 times/min, R: 23 times/min, BP: 131/96 mmHg |
Other physical examination items | Mind clear. The skin of the extremities and lips were dry. The abdomen was flat and soft. There was no muscle tension. There was no tenderness or rebound tenderness over entire abdomen. The frequency of bowel sound was 3 times/min | Mind clear. The skin and sclera were yellow, the abdomen was soft, the upper abdomen was tender, and there was no rebound pain. The liver was large, 2 cm below the ribs. There was no edema in the lower limbs, and the muscle strength and muscle tension of the limbs were normal | The patient was in a coma, has no stinging eyes, tingles and bends, and can produce a single tone. The examination was uncooperative, the pupils were symmetrical, the light reflex was slow, and the sclera and skin and mucosa were yellow. Abdominal eminence corresponds to gestational age. Old surgical scar can be seen in the right lower abdomen. The patient did not cooperate with examinations of abdominal tenderness and rebound pain. Bowel sounds are high, about 10 times per minute. Did not cooperate with muscle strength and muscle tension tests of limbs |
White blood cells | 19.24 × 109/L | 8.16 × 109/L | 13.31 × 109/L |
Percentage of neutrophils | 95.4% | 77.7% | – |
Platelets | 68 × 109/L | – | 48 × 109/L |
3P test | Negative (−) | Negative (−) | Positive (+) |
d-dimer | 1.13 mg/L | – | 39.13 mg/L |
ALT | 126 U/L | 39 U/L | 571 U/L |
AST | 139 U/L | 48 U/L | 119 U/L |
Blood ammonia | – | – | 138.8 μmol/L |
Prothrombin time and ratio | 11.5 s; 0.96 | – | 16.9 s; 1.41 |
Fibrinogen | 1.39 g/L | 1.44 g/L | 1.51 g/L |
Total bilirubin | – | 23.9 μmol/L | 195.7 μmol/L |
Cardiopulmonary | No abnormalities | – | – |
Abdomen | There was gallbladder after meals. No obvious abnormalities in liver and spleen. The pancreas was unclear. No obvious abnormalities were found in kidneys and ureters | – | – |