Ganzert et al developed a decision model for managing a patient exposed to amatoxin. This can help to select those patients who require a liver transplant. The authors are from the Technical University of Munich.
Patient selection: acute exposure to amatoxin from Amanita, Lepiota and Galerina species
Testing performed from 3 to 11 days after the ingestion:
(1) serum creatinine in µmol/L
(2) prothrombin index (PI) in percent
|
Parameter
|
Finding
|
Points
|
|
serum creatinine
|
<= 106 µmol/L
|
0
|
|
|
> 106 µmol/L
|
1
|
|
prothrombin index
|
>= 25% of normal
|
0
|
|
|
< 25% of normal
|
1
|
where:
• Most laboratories in the US use the prothrombin time rather than the PI.
A liver transplant was performed if:
(1) Both the serum creatinine and prothrombin index are abnormal on Day 3 (with ingestion Day 0), OR
(2) Both the serum creatinine and prothrombin index are abnormal on any day afterwards up through Day 10.
A liver transplant is not performed if:
(1) Both the serum creatinine and prothrombin index are normal on Day 3 (with ingestion Day 0), OR
(2) Both the serum creatinine and prothrombin index are normal on any day afterwards up through Day 10, OR
(3) The patient survives to Day 11.
If one of two tests is abnormal while the other is normal, then patient is monitored and the tests repeated the next day, through Day 10.
