Toxic Fungi of Western North America
Clinical course and treatment
Following a delay of 3-16 days intense thirst, often with burning in the mouth, occur. The victims usually urinate large amounts despite increasing kidney failure. Later urination decreases as kidney tubule cells completely fail and die. Gastrointestinal symptoms may also be present. In severe cases renal tubular necrosis and fatty degeneration of the liver may result in death, usually several weeks later. At least 85%-90% of patients recover over a period of some months. Current intensive therapy should greatly reduce the 10-15% death rates reported from Eastern Europe.
Treatment is largely symptomatic: intravenous fluids and electrolytes, cardiovascular monitoring and early kidney dialysis before irreversible damage occurs. Furosemide, a “loop” diuretic (one which works principally on the thin loops of the kidney tubules), appears to increase toxicity; other diuretics may also be dangerous. However, during renal dialysis one can adjust fluid and electrolyte levels at the same time that one is removing the body’s waste products. Renal damage is primarily confined to the proximal tubules with fibrosis around them. This scarring, when severe, seals off these tubules. (135) Kidney tubule scarring, once done, is not reversible and such patients may require intermittent life-long dialysis. Some improvement occurs in occasional patients, presumably because some tubular cells were swollen with inflammation and not blocked by fibrosis of the lumen.