Decontamination

Gastrointestinal decontamination with activated charcoal is important in suspected Amanita phalloides or other cyclopeptide mushroom ingestion. Amatoxin undergoes significant enterohepatic recycling, remaining in the portal circulation for a long time after mushroom ingestion. Even if the patient presents 2 days after ingestion, giving activated charcoal is likely to be beneficial.

Give activated charcoal to all alert and cooperative patients who are able to protect their airway. If the patient is intubated, activated charcoal can be given any time after ingestion via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.