Hemorrhagic Diathesis in Amanita Phalloides Poisoning

In human amanita phalloides poisoning the severity of the disease as well as the different hospitalisation time after toxin uptake allow no clear interpretation of blood clotting analysis. Therefore the coagulation changes were examined in a standardized animal model in relation to the given dose. Due to the main responsibility of amanitin for the clinical picture Gamma-Methyl-Amanitin (0,05–0,08 mg/kg) was administered intravenously in 20 beagle dogs. Depending on the given dose three different groups could be observed: Group I (amanitin > 0,07 mg/kg): Death in hypoglycemic shock 20-40 hours after poisoning. No manifest hemorrhagic diathesis. Histologically no fibrin clots. Coagulation analysis: DIC (presence of fibrinmonomers) with predominant fibrinolysis, increased level of FDP (> 120 ug/ml). Within 24 hours decrease of coagulation factors, Fibrinogen, F. II, V, VIII, XIII (< 10%) and platelets (< 30,000). Group II (amanitin 0,05–0,07 mg/kg): A. 70% of the animals survived with signs of hemorrhagic diathesis. Histologically no fibrin clots. Coagulation analysis: Decrease of clotting factors and of platelets to about 50% with nadir after 48 h. Maximal fibrinolysis after 36 h. Normalisation after 120 h. B. Protracted decrease of the clotting factors and platelets to 7000 after 60 h. Marked fibrinolysis with death in hemorrhagic shock. Histologically fibrin clots. Comment: In relation to the dose a different reaction of the clotting system can be stated: I. In cases of massive poisoning an endotoxinshock-like picture could be shown. Predominant fibrinolysis. II. With lower dose of amanitin a moderate consumption coagulopathy with moderate, secondary fibrinolysis (A), or (B) predominant consumption coagulopathy with marked fibrinolysis and death in hemorrhagic shock.