Svetozár Dluholucký, Mária Knapková, Mária Cibirová
Amanita phalloides (death cap) poisoning is still the most frequent cause of death with poison of biological origin in the countries where collecting and eating wild mushrooms is traditional. Diagnostic procedures of amatoxin intoxication (AI) are cumbersome, treatment procedures variable, predominantly symptomatic, leading to orthotopic liver transplantation (OLTx). Authors present the protocol of AI, originated on the basis of available knowledge in late 70thies and used with minimal improvements until now. Its acronym ‘RELDADKOM ‘ reflects the abbreviations of single therapeutic steps. Since 2004 the mentioned mode of AI management has been enriched by the quantitative ELISA investigation of alpha and gamma amanitins in serum (ATOs) and urine (ATOu). Since this time this diagnostic procedure has been performed as ‘the statim investigation’ for all departments in Slovakia. Simultaneously the mode of treatment according the mentioned protocol was desired and guided by the author. During 2004 - 2010 years the 302 suspected patients – ATOs samples - were investigated and 72 positive AI were diagnosed and treated (68 by ATOu ELISA, 4 by spores). Two patients succumbed to AI; and OLTx were performed in next three patients. In all five patients the principal modifications of the treatment protocol were done (four times without PNC and once with renal failure due of dehydration). Summarising the result since 1978, the total mortality from 104 treated patients (32 children) is 4.8 % and total failure rate (death plus OLTx) is 10,6 % - all survived are without long-term sequelae. The algorithm of the AI management is suggested.