KINETICS OF AMATOXINS IN HUMAN POISONING - THERAPEUTIC IMPLICATIONS

被引:161
作者
JAEGER, A
JEHL, F
FLESCH, F
SAUDER, P
KOPFERSCHMITT, J
机构
[1] UNIV STRASBOURG 1,FAC MED,INST BACTERIOL,F-67070 STRASBOURG,FRANCE
[2] UNIV STRASBOURG HOP,HOP CIVIL,CTR ANTIPOISONS,F-67091 STRASBOURG,FRANCE
来源
JOURNAL OF TOXICOLOGY-CLINICAL TOXICOLOGY | 1993年 / 31卷 / 01期
关键词
AMATOXIN; AMANITINS; KINETICS; POISONING; HUMAN; TREATMENT;
D O I
10.3109/15563659309000374
中图分类号
R99 [毒物学(毒理学)];
学科分类号
100405 ;
摘要
The kinetics of alpha and beta amanitin were studied in 45 patients intoxicated with Amanita Phalloides. The amatoxins were analyzed by high performance liquid chromatography in plasma (43 cases), urine (35 cases), gastroduodenal fluid (12 cases), feces (12 cases) and tissues (4 cases). All patients had gastrointestinal symptoms and 43 developed an acute hepatitis. Two patients underwent successful liver transplantation. Eight patients, of whom three were children, died. The detection of amatoxins in the biological fluids was time dependent. The first sample was obtained at an average of 37.9 h post ingestion in the patients with positive results and at 70.6 h in the samples without detectable amatoxins. Plasma amatoxins were detected in 11 cases at 8 to 190 ng/mL for alpha and between 23.5 to 162 ng/mL for beta. In 23 cases amatoxins were detected in urine with a mean excretion per hour of 32.18 mug for alpha and 80.15 mug for beta. in 10 patients the total amounts eliminated in the feces (time variable) ranged between 8.4 and 152 mug for alpha amanitin and between 4.2 and 6270 mug for beta amanitin. In three of four cases amatoxins were still present in the liver and the kidney after day 5. Amatoxins were usually detectable in plasma before 36 h but were present in the urine until day 4. The rapid clearance indicates that enhanced elimination of amatoxins requires early treatment. Clearance of circulating amatoxins by day 4 spares the transplanted liver.
引用
收藏
页码:63 / 80
页数:18
相关论文
共 27 条
[1]   [I-125] AMATOXIN AND ANTI-AMATOXIN FOR RADIOIMMUNOASSAY PREPARED BY A NOVEL-APPROACH - CHEMICAL AND STRUCTURAL CONSIDERATIONS [J].
ANDRES, RY ;
FREI, W .
TOXICON, 1987, 25 (09) :915-922
[2]  
BECKER CE, 1986, W J MED, V14, P100
[3]  
BIVINS HG, 1985, ANN EMERG MED, V14, P101
[4]  
BOUDJEMA K, 1989, PRESSE MED, V18, P937
[5]  
BUSI C, 1979, NEW ENGL J MED, V5, P800
[6]  
BUSI C, 1977, NOUV PRESSE MED, V6, P855
[7]   DIRECT, SIMULTANEOUS DETERMINATION OF ALPHA-AMANITIN, BETA-AMANITIN AND PHALLOIDINE BY HIGH-PERFORMANCE LIQUID-CHROMATOGRAPHY [J].
CACCIALANZA, G ;
GANDINI, C ;
PONCI, R .
JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS, 1985, 3 (02) :179-185
[8]   TOXICOKINETICS OF LABELED AMATOXINS IN THE DOG [J].
FAULSTICH, H ;
TALAS, A ;
WELLHONER, HH .
ARCHIVES OF TOXICOLOGY, 1985, 56 (03) :190-194
[9]  
FAULSTICH H, 1973, DEUT MED WOCHENSCHR, V98, P2258
[10]  
FAUSER U, 1973, DEUT MED WOCHENSCHR, V98, P2259