Volume 4 • Issue 5 • 1000160 J Drug Metab Toxicol ISSN: 2157-7609 JDMT, an open access journal Research Article Open Access Akın et al., J Drug Metab Toxicol 2013, 4:5 DOI: 10.4172/2157-7609.1000160 Research Article Open Access *Corresponding authors: Şakir Özgür Keşkek, Ministry of Health, Adana Numune Education and Training Hospital, Internal Medicine Clinic, Yüreğir, Adana, Turkey, Tel: +905052996942; E-mail: drkeskek@yahoo.com Received November 13, 2013; Accepted December 18, 2013; Published December 20, 2013 Citation: Akın A, Keşkek ŞÖ, Kılıç DA, Aliustaoğlu M, Keşkek NŞ (2013) The Effects of N-acetylcysteine in Patients with Amanita phalloides Intoxication. J Drug Metab Toxicol 4: 160. doi:10.4172/2157-7609.1000160 Copyright: © 2013 Akın A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Objectives: Mushroom intoxication with Amanita phalloides has a high incidence throughout the world. Treatment for this intoxication is similar in different centers, but N-acetylcysteine is rarely used. In this study, we aimed to investigate the effects of N-acetylcysteine treatment in patients with Amanita phalloides intoxication. Methods: A total of 40 patients with Amanita phalloides intoxication were included in this retrospective study. The study group consisted of 24 patients who were administered N-acetylcysteine in addition to the standard regimen; the control group consisted of 16 patients who were treated only with the standard treatment. Treatment results and biochemical measurements of groups were compared. Results: According to the biochemical measurements, it was found that patients in the control group were affected more seriously by Amanita phalloides than those in the study group. The mortality rate was lower in the study group (4.4% vs. 18.7% in the control group). Conclusions: Amanita phalloides intoxication can be successfully treated with N-acetylcysteine in addition to the standard regimen. Signifcantly, the simplicity of administration, good tolerance, and an affordable cost make N-acetylcysteine a viable option for the treatment of Amanita phalloides intoxication. The low mortality rate presented in the study group may be ascribed to N-acetylcysteine administration. The Effects of N-acetylcysteine in Patients with Amanita phalloides Intoxication Ahmet Akın 1 , Şakir Özgür Keşkek 2 *, Didem Aydın Kılıç 1 , Mehmet Aliustaoğlu 1 and Nedime Şahinoğlu Keşkek 3 1 Ministry of Health, Dr Lütf Kırdar Kartal Education and Training Hospital, Internal Medicine Clinic, Istanbul, Turkey 2 Ministry of Health, Adana Numune Education and Training Hospital, Internal Medicine Clinic, Yüreğir, Adana, Turkey 3 Ministry of Health, Adana Numune Education and Training Hospital, Ophthalmology Clinic, Yüreğir, Adana, Turkey Keywords: Amanita phalloides; Intoxication; N-acetylcysteine Introduction Mushroom intoxication is the most common vegetal intoxications in Turkey and in other parts of the world [1,2]. It may result in several disorders, ranging from mild gastroenteritis to severe fulminant hepatic failure. Te main cause of mortality is amatoxin, Amanita phalloides (A. phalloides) toxin, which leads to very high mortality rates up to >20% in adults and >50% in children [3]. Amatoxin noncompetitively inhibits RNA polymerase II or B, which is dependent on DNA. Bromelain, cysteine proteinase, cathepsin, cathepsin L, and papain are released [4]. Inhibition of mRNA synthesis in hepatocytes causes a decrease in coagulation factor and immunoglobulin production. In addition, another toxin, phallotoxin, tends to adhere to microflament structures and causes cholestasis by stabilizing F actin flaments. Although the main target tissue of A. phalloides is the liver, kidney cells may also be afected. Expectedly, intoxication frequency exhibits seasonal variation, with a signifcant increase during fall, concurrent with the rains. N-acetylcysteine (NAC) has anti-infammatory, antioxidant, inotropic, and vasodilating efects that improve microcirculatory blood fow and oxygen delivery to vital organs [5]. It also supplies sulfydryl groups to act as a substrate for detoxifying reactive toxic intermediates [6]. NAC may beneft patients with non-acetaminophen-induced acute liver failure by improving systemic hemodynamics via tissue oxygen delivery or other favorable efects on the acutely injured liver. Benefts are seen when NAC is used in the early stages of liver failure [7]. Studies on the efects of NAC on Amanita phalloides intoxication are very rare. Furthermore, in some previous research, NAC was administered with the standard regimen, which includes silibinin and other treatments such as plasmapheresis, so it is difcult to show the clear efect of NAC on A. phalloides intoxication in these studies [8-10]. In the present research, we aimed to investigate the benefts of N-acetylcysteine treatment in addition to the standard treatment in patients with A. phalloides intoxication. Material and Methods In this study, data from 40 patients with A. phalloides intoxication who were treated at the Internal Medicine Clinic of our institute from 2001 to 2006 were studied retrospectively. Te institutional review board of our hospital approved the study. Mushroom intoxication patients with any comorbidity and/or patients who were admitted to the hospital more than 24 hours afer ingestion were excluded. Patients were divided into two groups. Te study group consisted of 24 patients who were administered N-acetylcysteine in addition to the standard regimen, while the control group consisted of 16 patients who were treated only with the standard treatment. According to the standard treatment, nasogastric tubes and gastric enemas were applied to patients who presented in the frst 24 hours. Additionally, hemoperfusion was performed, and intravenous penicillin G (1 million units/kg/day) infusion, activated charcoal (5 g/day), and lactulose (4 g/day) were administered in three divided J o u r n a l o f D r u g M e t a b o li s m & T o x i c o l o g y ISSN: 2157-7609 Journal of Drug Metabolism and Toxicology