Table 1.
Patient Characteristics.
| Parameters | Patient 1: mother | Patient 2: son | Patient 3: daughter |
|---|---|---|---|
| Residence | Rural, hills | Rural, hills | Rural, hills |
| Type of mushroom consumed | Wild | Wild | Wild |
| Onset of symptoms after consumption | 4 h | 4–5 h | 6 h |
| Initial symptoms | Pain abdomen, vomitings, bloody diarrhea | Pain abdomen, vomitings, bloody diarrhea | Pain abdomen, vomitings, bloody diarrhea |
| Resolution of initial symptoms | 24–28 h | 28–30 h | 30–36 h |
| Period of convalescence | 8–10 h | 8–10 h | 8–10 h |
| Progression of symptoms | Jaundice, altered sensorium | Jaundice, altered sensorium | Jaundice, altered sensorium |
| Day of admission to ICU | 4th | 4th | 5th |
| General examination findings | Pallor, icterus | Pallor, icterus | Icterus |
| CNS examination | Grade 3 hepatic encephalopathy | Grade 3–4 hepatic encephalopathy | Grade 3 hepatic encephalopathy |
| Hyperreflexia | Arreflexia | Hyperreflexia | |
| Planters down going | Planters mute | Planters down going | |
| Normal tone | Hypertonia | Normal tone | |
| Investigations: Hemoglobin | 7.6 g/dl | 10.7 g/dl | 12.1 g/dl |
| Leukocyte count | 16000/mm3 | 5000/mm3 | 9200/mm3 |
| AST/ALT | 1580/2400 U/L | 2814/3759 U/L | 573/1463 U/L |
| Bilirubin total/conjugated | 5.7/4.6 mg/dl | 5.2/3.1 mg/dl | 5.2/3.6 mg/dl |
| Prothrombin time | >2 min | >2 min | >2 min |
| Serum sodium | 125 meq/L | 135 meq/L | 137 meq/L |
| Serum creatinine | 2.8 mg/dl | 0.5 mg/dl | 3.0 mg/dl |
| Arterial gases | Metabolic acidosis | Metabolic acidosis | Metabolic acidosis |
| Urine routine | Normal | Normal | Normal |
| USG abdomen | Raised liver echogenicity, 13.4 cm GB wall thickening, pericholecystic fluid, bilateral renal parenchymal disease, ascites | Raised liver echogenicity, 12.4 cm No ascites | Raised liver echogenicity, 11.5 cm GB wall thickening, pericholecystic fluid, bilateral renal parenchymal disease, ascites, bilateral mild pleural effusion |
| Management | ICU based including penicillin and silibinin | ICU based including penicillin and silibinin | ICU based including penicillin and silibinin |
| Course | |||
| DIC | Present | Present | Present |
| Onset of hypotension | 10 h | 20 h | 24 h |
| Demise | 12 h | 24 h | 60 h |
| Terminal events | Refractory shock, MODS, sinus bradycardia | Refractory shock, MODS | Refractory shock, MODS, ventricular fibrillation, seizures |