Vomiting, lavage, or catharsis should be initiated unless vomiting has already occurred spontaneously. It is also recommended that an activated charcoal slurry be given every 4 hours for the first 24–48 hours. In addition, administration of penicillin and Silybum marianum (a milk thistle) should be given within 48 hours after ingestion of the poisonous mushroom. These may help prevent severe injury to the liver. An antidote, Legalon® SIL is now available in the United States for Amanitin poisoning through an open NIH clinical trial. Early administration of this antidote is reported to reduce the mortality rate from 50% to 10%. Physicians suspicious of Amanitin poisoning should call the toll-free 24-hour hotline. Once it has been determined that the case qualifies, a supply of the antidote will be shipped overnight, free of charge, to the hospital pharmacy. However, The Poison Control Center of The Children’s Hospital of Philadelphia recommends that health care providers should cautiously consider any recommendations from the hotline and make clinical decisions for their patients on an individual basis.
