Treatment for liver failure

If a patient with Amanita phalloides poisoning has evidence of acute liver injury, seek advice from a clinical toxicologist or liver unit. A liver transplant may be required if:

• the time between ingestion and onset of diarrhoea is short (ie 6 to 10 hours)
• the INR is more than 6.0 from day 4 after ingestion.

Encephalopathy is not an absolute prerequisite for liver transplant.

Amatoxin can be detected in blood for up to 2 days and in urine for up to 4 days. To reduce the risk of residual amatoxin poisoning in the transplanted liver, wait at least 4 days after ingestion before undertaking a liver transplant.