Enhanced elimination

Multiple-dose activated charcoal

Amatoxin undergoes enterohepatic recycling, so multiple-dose activated charcoal can enhance elimination and potentially reduce the amount of amatoxin absorbed by hepatocytes in patients with Amanita phalloides poisoning. Multiple-dose activated charcoal works in combination with other treatments (eg silibinin) that inhibit intracellular transport of amatoxin.

If considering the use of multiple-dose activated charcoal, seek advice from a clinical toxicologist. Patients must be alert, cooperative and able to protect their airway to drink a dose of activated charcoal, or be intubated and receive activated charcoal via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.

Extracorporeal elimination

Haemodialysis does not enhance removal of amatoxin, but may be beneficial as supportive therapy for acute kidney injury and metabolic disturbances (eg metabolic acidosis) in patients with Amanita phalloides poisoning.

For more information on extracorporeal enhanced elimination techniques, such as haemodialysis, see here.