JIST

Abstract

Aim: To determine the environmental, clinical and laboratory parameters in cases of mushroom poisoning. To correlate those parameters with the outcome of the patient, calculate the Kings College Criteria(non-paracetamol) in cases with acute liver failure, and to correlate the King’s college Criteria (non -paracetamol) with the outcome of the patient. 

Materials and Methods: A hospital based retrospective study was done at a tertiary care centre of upper assam on the presenting patients showing symptoms after recent mushroom ingestion over the span of six months. Retrospective analysis of history charts, examination findings, laboratory investigations was done to determine environmental, clinical and laboratory parameters which were then correlated with the outcome of patients using statistical analysis. In the subset of patients showing acute liver failure, Kings college Criteria (non -paracetamol) was applied and correlated with the outcome.

Results:  Out of 45 total patients ,41 patients could take part in study. Significant difference in mortality (p=0.003) was noted with delayed onset of symptoms (>6 hrs) when compared to early symptoms.  14 patients expired in our study. We found that AST,ALT ,PT,INR  values from day 2 in expired group (AST,ALT>2500 and PT/INR>30/ 3.0)are significant with mortality.(p<.05).In our study it was found that there is a significant difference in mortality in those who present to hospital early and those who present late(p=0.01) .In our study ,out of nine patients who had documented acute liver failure  , only four of them fulfilled kings college criteria and all of them expired ,thus having a 100 percent positive  predictive value for mortality.

Conclusion: we have coupled all the biochemical and clinical factors which have a relationship with severity. We have shown that elevated liver enzymes (>2000), elevated coagulation profile, delayed time of onset of symptoms, delayed hospitalization, development of hepatic encephalopathy to be directly predictive of severe poisoning and fatality