Acute liver injury, acute liver failure and acute on chronic liver failure: A clinical spectrum of poisoning due to Gyromitra esculenta

array:24 ["pii" => "S1665268119300420" "issn" => "16652681" "doi" => "10.1016/j.aohep.2018.11.009" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "34" "copyright" => "Fundación Clínica Médica Sur, A.C." "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Ann Hepatol. 2019;18:514-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 337 "formatos" => array:3 [ "EPUB" => 26 "HTML" => 229 "PDF" => 82 ] ] "itemSiguiente" => array:17 [ "pii" => "S1665268119302273" "issn" => "16652681" "doi" => "10.1016/j.aohep.2019.05.001" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "69" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "nws" "cita" => "Ann Hepatol. 2019;18:517" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 193 "formatos" => array:3 [ "EPUB" => 17 "HTML" => 54 "PDF" => 122 ] ] "en" => array:6 [ "idiomaDefecto" => true "titulo" => "AMH NEWSLETTER" "tienePdf" => "en" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "517" ] ] "contienePdf" => array:1 [ "en" => true ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119302273?idApp=UINPBA00004N" "url" => "/16652681/0000001800000003/v2_201906020907/S1665268119302273/v2_201906020907/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119300493" "issn" => "16652681" "doi" => "10.1016/j.aohep.2018.10.006" "estado" => "S300" "fechaPublicacion" => "2019-05-01" "aid" => "41" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Ann Hepatol. 2019;18:508-13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 248 "formatos" => array:3 [ "EPUB" => 20 "HTML" => 109 "PDF" => 119 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Case report" "titulo" => "Transfer of peanut allergy from donor to recipient after liver transplant" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "508" "paginaFinal" => "513" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Avin Aggarwal, Rilwan Balogun, Tara F. Carr, Archita P. Desai, Tun Jie, Jen-Jung Pan" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Avin" "apellidos" => "Aggarwal" ] 1 => array:2 [ "nombre" => "Rilwan" "apellidos" => "Balogun" ] 2 => array:2 [ "nombre" => "Tara F." "apellidos" => "Carr" ] 3 => array:2 [ "nombre" => "Archita P." "apellidos" => "Desai" ] 4 => array:2 [ "nombre" => "Tun" "apellidos" => "Jie" ] 5 => array:2 [ "nombre" => "Jen-Jung" "apellidos" => "Pan" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300493?idApp=UINPBA00004N" "url" => "/16652681/0000001800000003/v2_201906020907/S1665268119300493/v2_201906020907/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Case report" "titulo" => "Acute liver injury, acute liver failure and acute on chronic liver failure: A clinical spectrum of poisoning due to Gyromitra esculenta" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "516" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Magdalena Arłukowicz-Grabowska, Maciej Wójcicki, Joanna Raszeja-Wyszomirska, Monika Szydłowska-Jakimiuk, Bernard Piotuch, Piotr Milkiewicz" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Magdalena" "apellidos" => "Arłukowicz-Grabowska" "email" => array:1 [ 0 => "arlukowicz.m@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Maciej" "apellidos" => "Wójcicki" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Joanna" "apellidos" => "Raszeja-Wyszomirska" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Monika" "apellidos" => "Szydłowska-Jakimiuk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Bernard" "apellidos" => "Piotuch" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Piotr" "apellidos" => "Milkiewicz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Surgery, Ministry of the Interior and Administration Hospital, Szczecin, Poland" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Translation Medicine Group, Pomeranian Medical University, Szczecin, Poland" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1803 "Ancho" => 2083 "Tamanyo" => 441218 ] ] "descripcion" => array:1 [ "en" => "(a) Gyromitra esculenta, “false morel”. (b) Morchella esculenta, “true morel”." ] ] ] "textoCompleto" => "1IntroductionAmong thousands of mushroom species that are found all over the world, approximately one hundred are poisonous to humans. Most of them cause mild symptoms, such as gastrointestinal disturbances like nausea, vomiting, diarrhea, or other manifestations like fever, muscle pain and a headache. Poisonous mushroom ingestion could also result in severe, life-threatening toxicity <a class="elsevierStyleCrossRef" href="#bib0100">[1]</a>.Acute liver failure (ALF) manifests with abnormal liver functions with impaired coagulation (INR >1.5) and signs of encephalopathy, and manifestations of the latter could be up to 24 weeks from onset of illness in a patient with no previous history of liver disease. Whereas the term of acute liver injury (ALI) refers to patients with coagulopathy and no signs of encephalopathy <a class="elsevierStyleCrossRefs" href="#bib0105">[2,3]</a>. Its occurrence following Amanita phalloides mushroom poisoning is well known with the associated morbidity, mortality and often the need for liver transplantation in a significant proportion of cases. However, ALF due to Gyromitra esculenta mushrooms ingestion is less well reported.G. esculenta, also known as a “false morel” (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a), is well documented as one of the most poisonous mushrooms. This species grow all over the world mostly in coniferous forests in early spring time. The mushroom is of medium size (5 up to 16cm) with a typical irregular ‘brain-shaped’ cap (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). Unfortunately, “false morel” is easily confused with Morchella esculenta (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b), which is known as a “true morel” and an exclusive culinary product <a class="elsevierStyleCrossRef" href="#bib0115">[4]</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Herein, we describe a case of acute liver injury, a case of ALF and an additional case of acute-on-chronic liver failure (ACLF) due to G. esculenta poisoning. Two patients recovered following typical medical treatment while a patient with acute-on-chronic liver failure died.2Case 1 – acute liver injuryA 61-year-old male patient was admitted to our unit in April 2014, two days after eating “brain-like” mushrooms. The patient experienced abdominal pain two days after the mushroom ingestion and this was associated with vomiting, intense watery diarrhea, and on admission was jaundiced. There were no signs of encephalopathy. Laboratory tests confirmed ALI (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Abdominal ultrasound showed signs of minor liver enlargement. Following supportive medical treatment the liver functions improved. The patient was discharged home 9 days after admission.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>3Case 2 – acute liver failureA 67-year-old male patient was admitted to our Unit in April 2016 with signs of abdominal pain, fever, headache and jaundice that were followed by altered mentation. This occurred three days after ingestion of mushrooms, which the patient described as being very similar to “true morels”. The patient was irritable, mildly confused and found to be jaundiced with a tender right upper quadrant of abdomen. Laboratory blood tests confirmed acute liver failure (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) and the patient had signs of encephalopathy grade 3 according to West Haven Criteria <a class="elsevierStyleCrossRef" href="#bib0120">[5]</a>. The patient continued to deteriorate despite supportive care and required listing for a liver transplantation. The decision for liver transplantation was based primarily on rapidity and severity of deterioration even though the patient did not fulfill all of the Kings College criteria <a class="elsevierStyleCrossRef" href="#bib0125">[6]</a> for listing in fulminant hepatic failure. The clinical picture however stabilized and there was improvement noted in the 48h that followed resulting in the patient being taken off the waiting list for a transplant. After eleven days of continued medical treatment, the patient improved to be discharged home with liver function tests normalized.4Case 3 – acute-on-chronic liver failureA 59-year-old man with a history of HCV hepatitis (untreated, diagnosed in 2002) and diabetes presented in April 2016, three days after eating mushrooms, which his family described as a “false morel”. A few hours after ingestion symptoms including muscle pain with vomiting and diarrhea were observed. At admission he had grade 3 encephalopathy. The patient rapidly developed multi-organ failure requiring inotrope support, invasive ventilator support and hemodialysis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). He also required glucose infusion to maintain normoglycemia. He received a standard treatment with intravenous colloids, crystalloids and glucose. His encephalopathy was treated with intravenous l-ornithine l-aspartate. The abdominal ultrasound revealed enlarged and heterogenous liver parenchyma with no signs of portal hypertension and normal spleen. The patient did not however fulfill the Kings College criteria <a class="elsevierStyleCrossRef" href="#bib0125">[6]</a>. Despite signs of continued deterioration of liver function the option of liver transplantation was not considered feasible due to established multi-organ failure. The patient died 5 days following mushroom ingestion.5DiscussionThere are various types of wild mushrooms growing in forests, which are often eaten by foragers. Only about 2% (out of more than 5000 species that are found worldwide) are poisonous. This includes G. esculenta, so called “false morel” <a class="elsevierStyleCrossRef" href="#bib0130">[7]</a>. Herein, we describe the clinical course of three patients to emphasize variable symptoms of poisoning.The poisoning with G. esculenta should be considered and differentiated from other causes of toxic liver failure which occur in the spring time, as opposed to A. phalloides occurring in autumn. It is also not typically shaped with a stem and a cap <a class="elsevierStyleCrossRefs" href="#bib0135">[8,9]</a>.The manifestations of poisoning following ingestion of G. esculenta usually occur around 12h following ingestion with gastrointestinal symptoms followed by jaundice within 2–3 days and significant increase of AST, ALT and INR with a degree of encephalopathy. There is a paucity of reported publications of poisoning following ingestion of G. esculenta, limited to a few case reports <a class="elsevierStyleCrossRefs" href="#bib0145">[10,11]</a>. In these too most patients described failed to fulfill criteria for ALF or even ALI, with moderate transaminitis being the main feature. However, fatal cases have also been reported <a class="elsevierStyleCrossRef" href="#bib0155">[12]</a>. The toxin gyromytrin, chemically identified as an N-methyl-N-formylhydrazone is a water soluble compound that evaporates easily at normal temperatures <a class="elsevierStyleCrossRef" href="#bib0160">[13]</a>. The toxin could be therefore partially deactivated or even eliminated by cooking or drying. However partial cooking could lead to hydrolyzation which could also be caused by the acidity of the stomach following ingestion, to the direct toxin-monomethylhydrazine (MMH). Metabolic intermediates of gyromytrin toxin-free methyl radical and an unstable diazonium compound, which arises after oxidation from MMH damage hepatocytes, causing their necrosis and interfere with cytochrome enzymes (mainly P450), aminooxidases and glutathione pathways <a class="elsevierStyleCrossRef" href="#bib0165">[14]</a>. This may be combined with a degree of neurotoxicity by modulating pyridoxine dependent coenzymes, therefore having influence on gamma-aminobutyric acid (GABA) levels <a class="elsevierStyleCrossRef" href="#bib0170">[15]</a>.The three patients described developed liver disfunction of varied severity following G. esculenta poisoning. Our report highlights the possibility G. esculenta ingestion may cause an acute liver failure. It is likely that in subjects with underlying or preexistent liver dysfunction the course may be very aggressive with death a likely outcome.Described cases show limited utility of widely used criteria selecting patient with urgent need of transplantation <a class="elsevierStyleCrossRef" href="#bib0125">[6]</a>. This reinforces the need to develop new prognostic or diagnostic tests of high sensitivity and specificity that would allow adequate placing patients on high urgency waiting list for liver transplantation.The clinical indications for emergency liver transplantation are commonly based on the King's College Hospital Criteria or Clichy criteria <a class="elsevierStyleCrossRef" href="#bib0125">[6]</a>. However, their sensitivity and specificity in patients with ALF due to some rare causes are not clearly specified. The utility of Kings College criteria has previously been evaluated in case of A. phalloides poisoning. Interestingly, the sensitivity of only 25% with 80% specificity of predicting poor outcome in case of amatoxin induced ALF have been reported <a class="elsevierStyleCrossRef" href="#bib0175">[16]</a>. This contradicts with a series reported by Escudie et al. <a class="elsevierStyleCrossRef" href="#bib0180">[17]</a> who reported Kings College sensitivity and specificity of 100% each in case of A. phalloides poisoning. According to Ganzert et al. <a class="elsevierStyleCrossRef" href="#bib0185">[18]</a>, the combination of serum creatinine above 106μmol/L and PT index less than 25% strongly suggests the urgent need for liver transplantation <a class="elsevierStyleCrossRef" href="#bib0185">[18]</a>.Some parameters may also be helpful in predicting prognosis, among them proven factors of poor outcome are: encephalopathy and kidney impairment <a class="elsevierStyleCrossRef" href="#bib0180">[17]</a>, lactic acidosis, especially when observed with coexisting hepatic encephalopathy <a class="elsevierStyleCrossRef" href="#bib0190">[19]</a>, time interval shorter than 8h between eating mushrooms and the occurrence of first symptoms (such as vomiting or diarrhea <a class="elsevierStyleCrossRef" href="#bib0175">[16]</a>. Nevertheless, majority of prognostic factors following mushroom intoxication refer to A. phalloides poisoning. In comparison however there is less known about G. esculenta poisoning to help with prognostication.In summary, G. esculenta poisoning represents a rare but potentially dangerous clinical scenario that should always be considered in the spring time in regions it is found. Given the limited sensitivity and specificity of currently available prognostic criteria, such patients should preferably be transferred to liver transplant and hepatology units early. Efforts should be made to develop more precise and sensitive prognostic criteria that could help clinicians in selecting the patients for liver transplantation.AbbreviationsACLFacute-on-chronic liver failureALFacute liver failureALIacute liver failureINRinternational normalized ratioGABAgamma-aminobutyric acidMMHmonomethylhydrazineConflict of interestNothing to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1199047" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1117487" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1 – acute liver injury" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2 – acute liver failure" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 3 – acute-on-chronic liver failure" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-07-28" "fechaAceptado" => "2018-11-28" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1117487" "palabras" => array:3 [ 0 => "Acute liver failure" 1 => "Mushroom poisoning" 2 => "Gyromitra esculenta" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Gyromitra esculenta, also known as “false morel” is one of the most poisonous mushrooms. This species is found all over the world, growing in coniferous forest in early spring time. Common manifestation of poisoning includes gastrointestinal symptoms which include varied degrees of liver impairment.We describe three cases: acute liver injury, acute liver failure and acute-on-chronic liver failure due to G. esculenta poisoning. At admission patients presented with encephalopathy and features of liver failure. Two of them recovered completely following supportive management while the remaining patient who also had preexisting liver disease developed multiorgan failure and subsequently died.Although a rare occurrence, G. esculenta poisoning should be considered in the differential diagnosis of acute liver failure." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1803 "Ancho" => 2083 "Tamanyo" => 441218 ] ] "descripcion" => array:1 [ "en" => "(a) Gyromitra esculenta, “false morel”. (b) Morchella esculenta, “true morel”." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Normal ranges: AST 5–40U/L; ALT 7–56U/L; INR 0.9–1.3; total bilirubin 0.2–1.2mg/dL; serum creatinine 0.6–1.2mg/dL; encephalopathy grade West Heaven 0–4.Abbreviations: ALT, alanine transaminase; AST, aspartate aminotransferase; S.cr, serum creatine; INR, international normalized ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AST IU/L \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ALT IU/L \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S. cr mg/dL \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bilirubin mg/dL \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">INR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Encephalopathy grade \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1032 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2248 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2422 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2657 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7605 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5183 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dead \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2047871.png" ] ] ] ] "descripcion" => array:1 [ "en" => "A comparison of laboratory features at admission between three cases after Gyromitra esculenta poisoning." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mushrooms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Persson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicine" "fecha" => "2016" "volumen" => "44" "paginaInicial" => "116" "paginaFinal" => "119" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0105" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "European Association for the Study of the Liver" 1 => "J. Wendon" 2 => "J. Cordoba" 3 => "A. Dhawan" 4 => "F.S. Larsen" 5 => "M. Manns" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2016.12.003" "Revista" => array:7 [ "tituloSerie" => "J Hepatol" "fecha" => "2017" "volumen" => "66" "paginaInicial" => "1047" "paginaFinal" => "1081" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28417882" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1525861013008001" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0110" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Association for the Study of Liver D AASLD position paper: the management of acute liver failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Polson" 1 => "W.M. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20703" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "1179" "paginaFinal" => "1197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15841455" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0115" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mistaken mushroom poisonings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.H. Diaz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.wem.2015.12.015" "Revista" => array:6 [ "tituloSerie" => "Wilderness Environ Med" "fecha" => "2016" "volumen" => "27" "paginaInicial" => "330" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27085814" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0120" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Montagnese" 1 => "A. Biancardi" 2 => "S. Schiff" 3 => "P. Carraro" 4 => "V. Carlà" 5 => "G. Mannaioni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.24043" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2011" "volumen" => "53" "paginaInicial" => "558" "paginaFinal" => "566" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21274876" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0125" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early indicators of prognosis in fulminant hepatic failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.G. O’Grady" 1 => "G.J. Alexander" 2 => "K.M. Hayllar" 3 => "R. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1989" "volumen" => "97" "paginaInicial" => "439" "paginaFinal" => "445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2490426" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0130" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Auerbach's wilderness medicine e-book" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.S. Auerbach" 1 => "T.A. Cushing" 2 => "N.S. Harris" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2016" "editorial" => "Elsevier Health Sciences" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0135" "etiqueta" => "[8]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poisoning due to raw Gyromitra esculenta (false morels) west of the Rockies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.M. Leathem" 1 => "T.J. Dorran" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "CJEM" "fecha" => "2007" "volumen" => "9" "paginaInicial" => "127" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17391587" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0140" "etiqueta" => "[9]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Syndromic diagnosis and management of confirmed mushroom poisonings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.H. Diaz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Crit Care Med" "fecha" => "2005" "volumen" => "33" "paginaInicial" => "427" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15699849" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022399911001693" "estado" => "S300" "issn" => "00223999" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0145" "etiqueta" => "[10]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. Vale" 1 => "S.M. Bradberry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2016" "paginaInicial" => "63" "paginaFinal" => "85" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0150" "etiqueta" => "[11]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute hepatotoxicity following ingestion of Gyromitra esculenta (false morel) mushrooms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Balterowich" 1 => "B. Blaney" 2 => "S. White" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Toxicol Clin Toxicol" "fecha" => "1996" "volumen" => "34" "paginaInicial" => "602" "itemHostRev" => array:3 [ "pii" => "S1525861015003072" "estado" => "S300" "issn" => "15258610" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0155" "etiqueta" => "[12]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of fatal poisoning by Gyromitra esculenta" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.V. Giusti" 1 => "A. Carnevale" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Toxicol" "fecha" => "1974" "volumen" => "33" "paginaInicial" => "49" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4480349" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0160" "etiqueta" => "[13]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poisoning by Gyromitra esculenta – a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Michelot" 1 => "B. Toth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Appl Toxicol" "fecha" => "1991" "volumen" => "11" "paginaInicial" => "235" "paginaFinal" => "243" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0165" "etiqueta" => "[14]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "On the occurrence of N-methyl-N-formylhydrazones in fresh and processed false morel, Gyromitra esculenta" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Pyysalo" 1 => "A. Niskanen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Agric Food Chem" "fecha" => "1977" "volumen" => "25" "paginaInicial" => "644" "paginaFinal" => "647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/558239" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0170" "etiqueta" => "[15]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer induction in mice by feeding the raw false morel mushroom Gyromitra esculenta" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Toth" 1 => "K. Patil" 2 => "H. Pyysalo" 3 => "C. Stessman" 4 => "P. Gannett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer Res" "fecha" => "1992" "volumen" => "52" "paginaInicial" => "2279" "paginaFinal" => "2284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1559231" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0175" "etiqueta" => "[16]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute liver injury and acute liver failure from mushroom poisoning in North America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.J. Karvellas" 1 => "H. Tillman" 2 => "A.A. Leung" 3 => "W.M. Lee" 4 => "M.L. Schilsky" 5 => "B. Hameed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.13080" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "1043" "paginaFinal" => "1050" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26837055" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0180" "etiqueta" => "[17]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Escudie" 1 => "C. Francoz" 2 => "J.P. Vinel" 3 => "R. Moucari" 4 => "M. Cournot" 5 => "V. Paradis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2006.10.013" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "466" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17188393" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0185" "etiqueta" => "[18]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Indication of liver transplantation following amatoxin intoxication" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Ganzert" 1 => "N. Felgenhauer" 2 => "T. Zilker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2004.10.023" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2005" "volumen" => "42" "paginaInicial" => "202" "paginaFinal" => "209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15664245" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0190" "etiqueta" => "[19]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute liver failure caused by mushroom poisoning: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Erden" 1 => "K. Esmeray" 2 => "H. Karagoz" 3 => "S. Karahan" 4 => "H.H. Gumuscu" 5 => "M. Basak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/IMCRJ.S53773" "Revista" => array:6 [ "tituloSerie" => "Int Med Case Rep J" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "85" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24294010" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001800000003/v2_201906020907/S1665268119300420/v2_201906020907/en/main.assets" "Apartado" => array:4 [ "identificador" => "77718" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001800000003/v2_201906020907/S1665268119300420/v2_201906020907/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300420?idApp=UINPBA00004N"]

Statistics

Case report

Magdalena Arłukowicz-Grabowskaa,

Corresponding author

arlukowicz.m@gmail.com

Corresponding author at: Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warsaw, Poland.

, Maciej Wójcickia, Joanna Raszeja-Wyszomirskaa, Monika Szydłowska-Jakimiuka, Bernard Piotuchb, Piotr Milkiewicza,c

a Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland

b Department of Surgery, Ministry of the Interior and Administration Hospital, Szczecin, Poland

c Translation Medicine Group, Pomeranian Medical University, Szczecin, Poland

Read

11881

Times
was read the article

1120

Total PDF

10761

Total HTML

Share statistics

 array:24 [
  "pii" => "S1665268119300420"
  "issn" => "16652681"
  "doi" => "10.1016/j.aohep.2018.11.009"
  "estado" => "S300"
  "fechaPublicacion" => "2019-05-01"
  "aid" => "34"
  "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "crp"
  "cita" => "Ann Hepatol. 2019;18:514-6"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 337
    "formatos" => array:3 [
      "EPUB" => 26
      "HTML" => 229
      "PDF" => 82
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "S1665268119302273"
    "issn" => "16652681"
    "doi" => "10.1016/j.aohep.2019.05.001"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "69"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "nws"
    "cita" => "Ann Hepatol. 2019;18:517"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 193
      "formatos" => array:3 [
        "EPUB" => 17
        "HTML" => 54
        "PDF" => 122
      ]
    ]
    "en" => array:6 [
      "idiomaDefecto" => true
      "titulo" => "AMH NEWSLETTER"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "517"
        ]
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119302273?idApp=UINPBA00004N"
    "url" => "/16652681/0000001800000003/v2_201906020907/S1665268119302273/v2_201906020907/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1665268119300493"
    "issn" => "16652681"
    "doi" => "10.1016/j.aohep.2018.10.006"
    "estado" => "S300"
    "fechaPublicacion" => "2019-05-01"
    "aid" => "41"
    "copyright" => "Fundaci&#243;n Cl&#237;nica M&#233;dica Sur&#44; A&#46;C&#46;"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Ann Hepatol. 2019;18:508-13"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 248
      "formatos" => array:3 [
        "EPUB" => 20
        "HTML" => 109
        "PDF" => 119
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Transfer of peanut allergy from donor to recipient after liver transplant"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "508"
          "paginaFinal" => "513"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Avin Aggarwal, Rilwan Balogun, Tara F&#46; Carr, Archita P&#46; Desai, Tun Jie, Jen-Jung Pan"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Avin"
              "apellidos" => "Aggarwal"
            ]
            1 => array:2 [
              "nombre" => "Rilwan"
              "apellidos" => "Balogun"
            ]
            2 => array:2 [
              "nombre" => "Tara F&#46;"
              "apellidos" => "Carr"
            ]
            3 => array:2 [
              "nombre" => "Archita P&#46;"
              "apellidos" => "Desai"
            ]
            4 => array:2 [
              "nombre" => "Tun"
              "apellidos" => "Jie"
            ]
            5 => array:2 [
              "nombre" => "Jen-Jung"
              "apellidos" => "Pan"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300493?idApp=UINPBA00004N"
    "url" => "/16652681/0000001800000003/v2_201906020907/S1665268119300493/v2_201906020907/en/main.assets"
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Acute liver injury&#44; acute liver failure and acute on chronic liver failure&#58; A clinical spectrum of poisoning due to <span class="elsevierStyleItalic">Gyromitra esculenta</span>"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "514"
        "paginaFinal" => "516"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Magdalena Ar&#322;ukowicz-Grabowska, Maciej W&#243;jcicki, Joanna Raszeja-Wyszomirska, Monika Szyd&#322;owska-Jakimiuk, Bernard Piotuch, Piotr Milkiewicz"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "Magdalena"
            "apellidos" => "Ar&#322;ukowicz-Grabowska"
            "email" => array:1 [
              0 => "arlukowicz.m@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Maciej"
            "apellidos" => "W&#243;jcicki"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Joanna"
            "apellidos" => "Raszeja-Wyszomirska"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Monika"
            "apellidos" => "Szyd&#322;owska-Jakimiuk"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Bernard"
            "apellidos" => "Piotuch"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Piotr"
            "apellidos" => "Milkiewicz"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Liver and Internal Medicine Unit&#44; Department of General&#44; Transplant and Liver Surgery&#44; Medical University of Warsaw&#44; Poland"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Surgery&#44; Ministry of the Interior and Administration Hospital&#44; Szczecin&#44; Poland"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Translation Medicine Group&#44; Pomeranian Medical University&#44; Szczecin&#44; Poland"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author at&#58; Liver and Internal Medicine Unit&#44; Department of General&#44; Transplant and Liver Surgery&#44; Medical University of Warsaw&#44; ul&#46; Banacha 1a&#44; 02-097 Warsaw&#44; Poland&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1803
            "Ancho" => 2083
            "Tamanyo" => 441218
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; <span class="elsevierStyleItalic">Gyromitra esculenta</span>&#44; &#8220;false morel&#8221;&#46; &#40;b&#41; <span class="elsevierStyleItalic">Morchella esculenta</span>&#44; &#8220;true morel&#8221;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Among thousands of mushroom species that are found all over the world&#44; approximately one hundred are poisonous to humans&#46; Most of them cause mild symptoms&#44; such as gastrointestinal disturbances like nausea&#44; vomiting&#44; diarrhea&#44; or other manifestations like fever&#44; muscle pain and a headache&#46; Poisonous mushroom ingestion could also result in severe&#44; life-threatening toxicity <a class="elsevierStyleCrossRef" href="#bib0100">&#91;1&#93;</a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Acute liver failure &#40;ALF&#41; manifests with abnormal liver functions with impaired coagulation &#40;INR &#62;1&#46;5&#41; and signs of encephalopathy&#44; and manifestations of the latter could be up to 24 weeks from onset of illness in a patient with no previous history of liver disease&#46; Whereas the term of acute liver injury &#40;ALI&#41; refers to patients with coagulopathy and no signs of encephalopathy <a class="elsevierStyleCrossRefs" href="#bib0105">&#91;2&#44;3&#93;</a>&#46; Its occurrence following <span class="elsevierStyleItalic">Amanita phalloides</span> mushroom poisoning is well known with the associated morbidity&#44; mortality and often the need for liver transplantation in a significant proportion of cases&#46; However&#44; ALF due to <span class="elsevierStyleItalic">Gyromitra esculenta</span> mushrooms ingestion is less well reported&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">G&#46; esculenta</span>&#44; also known as a &#8220;false morel&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#44; is well documented as one of the most poisonous mushrooms&#46; This species grow all over the world mostly in coniferous forests in early spring time&#46; The mushroom is of medium size &#40;5 up to 16<span class="elsevierStyleHsp" style=""></span>cm&#41; with a typical irregular &#8216;brain-shaped&#8217; cap &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46; Unfortunately&#44; &#8220;false morel&#8221; is easily confused with <span class="elsevierStyleItalic">Morchella esculenta</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#44; which is known as a &#8220;true morel&#8221; and an exclusive culinary product <a class="elsevierStyleCrossRef" href="#bib0115">&#91;4&#93;</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Herein&#44; we describe a case of acute liver injury&#44; a case of ALF and an additional case of acute-on-chronic liver failure &#40;ACLF&#41; due to <span class="elsevierStyleItalic">G&#46; esculenta</span> poisoning&#46; Two patients recovered following typical medical treatment while a patient with acute-on-chronic liver failure died&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0020">Case 1 &#8211; acute liver injury</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 61-year-old male patient was admitted to our unit in April 2014&#44; two days after eating &#8220;brain-like&#8221; mushrooms&#46; The patient experienced abdominal pain two days after the mushroom ingestion and this was associated with vomiting&#44; intense watery diarrhea&#44; and on admission was jaundiced&#46; There were no signs of encephalopathy&#46; Laboratory tests confirmed ALI &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Abdominal ultrasound showed signs of minor liver enlargement&#46; Following supportive medical treatment the liver functions improved&#46; The patient was discharged home 9 days after admission&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0025">Case 2 &#8211; acute liver failure</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 67-year-old male patient was admitted to our Unit in April 2016 with signs of abdominal pain&#44; fever&#44; headache and jaundice that were followed by altered mentation&#46; This occurred three days after ingestion of mushrooms&#44; which the patient described as being very similar to &#8220;true morels&#8221;&#46; The patient was irritable&#44; mildly confused and found to be jaundiced with a tender right upper quadrant of abdomen&#46; Laboratory blood tests confirmed acute liver failure &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; and the patient had signs of encephalopathy grade 3 according to West Haven Criteria <a class="elsevierStyleCrossRef" href="#bib0120">&#91;5&#93;</a>&#46; The patient continued to deteriorate despite supportive care and required listing for a liver transplantation&#46; The decision for liver transplantation was based primarily on rapidity and severity of deterioration even though the patient did not fulfill all of the Kings College criteria <a class="elsevierStyleCrossRef" href="#bib0125">&#91;6&#93;</a> for listing in fulminant hepatic failure&#46; The clinical picture however stabilized and there was improvement noted in the 48<span class="elsevierStyleHsp" style=""></span>h that followed resulting in the patient being taken off the waiting list for a transplant&#46; After eleven days of continued medical treatment&#44; the patient improved to be discharged home with liver function tests normalized&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="sect0030">Case 3 &#8211; acute-on-chronic liver failure</span><p id="par0035" class="elsevierStylePara elsevierViewall">A 59-year-old man with a history of HCV hepatitis &#40;untreated&#44; diagnosed in 2002&#41; and diabetes presented in April 2016&#44; three days after eating mushrooms&#44; which his family described as a &#8220;false morel&#8221;&#46; A few hours after ingestion symptoms including muscle pain with vomiting and diarrhea were observed&#46; At admission he had grade 3 encephalopathy&#46; The patient rapidly developed multi-organ failure requiring inotrope support&#44; invasive ventilator support and hemodialysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; He also required glucose infusion to maintain normoglycemia&#46; He received a standard treatment with intravenous colloids&#44; crystalloids and glucose&#46; His encephalopathy was treated with intravenous <span class="elsevierStyleSmallCaps">l</span>-ornithine <span class="elsevierStyleSmallCaps">l</span>-aspartate&#46; The abdominal ultrasound revealed enlarged and heterogenous liver parenchyma with no signs of portal hypertension and normal spleen&#46; The patient did not however fulfill the Kings College criteria <a class="elsevierStyleCrossRef" href="#bib0125">&#91;6&#93;</a>&#46; Despite signs of continued deterioration of liver function the option of liver transplantation was not considered feasible due to established multi-organ failure&#46; The patient died 5 days following mushroom ingestion&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">5</span><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">There are various types of wild mushrooms growing in forests&#44; which are often eaten by foragers&#46; Only about 2&#37; &#40;out of more than 5000 species that are found worldwide&#41; are poisonous&#46; This includes <span class="elsevierStyleItalic">G&#46; esculenta</span>&#44; so called &#8220;false morel&#8221; <a class="elsevierStyleCrossRef" href="#bib0130">&#91;7&#93;</a>&#46; Herein&#44; we describe the clinical course of three patients to emphasize variable symptoms of poisoning&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The poisoning with <span class="elsevierStyleItalic">G&#46; esculenta</span> should be considered and differentiated from other causes of toxic liver failure which occur in the spring time&#44; as opposed to <span class="elsevierStyleItalic">A&#46; phalloides</span> occurring in autumn&#46; It is also not typically shaped with a stem and a cap <a class="elsevierStyleCrossRefs" href="#bib0135">&#91;8&#44;9&#93;</a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The manifestations of poisoning following ingestion of <span class="elsevierStyleItalic">G&#46; esculenta</span> usually occur around 12<span class="elsevierStyleHsp" style=""></span>h following ingestion with gastrointestinal symptoms followed by jaundice within 2&#8211;3 days and significant increase of AST&#44; ALT and INR with a degree of encephalopathy&#46; There is a paucity of reported publications of poisoning following ingestion of <span class="elsevierStyleItalic">G&#46; esculenta</span>&#44; limited to a few case reports <a class="elsevierStyleCrossRefs" href="#bib0145">&#91;10&#44;11&#93;</a>&#46; In these too most patients described failed to fulfill criteria for ALF or even ALI&#44; with moderate transaminitis being the main feature&#46; However&#44; fatal cases have also been reported <a class="elsevierStyleCrossRef" href="#bib0155">&#91;12&#93;</a>&#46; The toxin gyromytrin&#44; chemically identified as an N-methyl-N-formylhydrazone is a water soluble compound that evaporates easily at normal temperatures <a class="elsevierStyleCrossRef" href="#bib0160">&#91;13&#93;</a>&#46; The toxin could be therefore partially deactivated or even eliminated by cooking or drying&#46; However partial cooking could lead to hydrolyzation which could also be caused by the acidity of the stomach following ingestion&#44; to the direct toxin-monomethylhydrazine &#40;MMH&#41;&#46; Metabolic intermediates of gyromytrin toxin-free methyl radical and an unstable diazonium compound&#44; which arises after oxidation from MMH damage hepatocytes&#44; causing their necrosis and interfere with cytochrome enzymes &#40;mainly P450&#41;&#44; aminooxidases and glutathione pathways <a class="elsevierStyleCrossRef" href="#bib0165">&#91;14&#93;</a>&#46; This may be combined with a degree of neurotoxicity by modulating pyridoxine dependent coenzymes&#44; therefore having influence on gamma-aminobutyric acid &#40;GABA&#41; levels <a class="elsevierStyleCrossRef" href="#bib0170">&#91;15&#93;</a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The three patients described developed liver disfunction of varied severity following <span class="elsevierStyleItalic">G&#46; esculenta</span> poisoning&#46; Our report highlights the possibility <span class="elsevierStyleItalic">G&#46; esculenta</span> ingestion may cause an acute liver failure&#46; It is likely that in subjects with underlying or preexistent liver dysfunction the course may be very aggressive with death a likely outcome&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Described cases show limited utility of widely used criteria selecting patient with urgent need of transplantation <a class="elsevierStyleCrossRef" href="#bib0125">&#91;6&#93;</a>&#46; This reinforces the need to develop new prognostic or diagnostic tests of high sensitivity and specificity that would allow adequate placing patients on high urgency waiting list for liver transplantation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The clinical indications for emergency liver transplantation are commonly based on the King&#39;s College Hospital Criteria or Clichy criteria <a class="elsevierStyleCrossRef" href="#bib0125">&#91;6&#93;</a>&#46; However&#44; their sensitivity and specificity in patients with ALF due to some rare causes are not clearly specified&#46; The utility of Kings College criteria has previously been evaluated in case of <span class="elsevierStyleItalic">A&#46; phalloides</span> poisoning&#46; Interestingly&#44; the sensitivity of only 25&#37; with 80&#37; specificity of predicting poor outcome in case of amatoxin induced ALF have been reported <a class="elsevierStyleCrossRef" href="#bib0175">&#91;16&#93;</a>&#46; This contradicts with a series reported by Escudie et al&#46; <a class="elsevierStyleCrossRef" href="#bib0180">&#91;17&#93;</a> who reported Kings College sensitivity and specificity of 100&#37; each in case of <span class="elsevierStyleItalic">A&#46; phalloides</span> poisoning&#46; According to Ganzert et al&#46; <a class="elsevierStyleCrossRef" href="#bib0185">&#91;18&#93;</a>&#44; the combination of serum creatinine above 106<span class="elsevierStyleHsp" style=""></span>&#956;mol&#47;L and PT index less than 25&#37; strongly suggests the urgent need for liver transplantation <a class="elsevierStyleCrossRef" href="#bib0185">&#91;18&#93;</a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Some parameters may also be helpful in predicting prognosis&#44; among them proven factors of poor outcome are&#58; encephalopathy and kidney impairment <a class="elsevierStyleCrossRef" href="#bib0180">&#91;17&#93;</a>&#44; lactic acidosis&#44; especially when observed with coexisting hepatic encephalopathy <a class="elsevierStyleCrossRef" href="#bib0190">&#91;19&#93;</a>&#44; time interval shorter than 8<span class="elsevierStyleHsp" style=""></span>h between eating mushrooms and the occurrence of first symptoms &#40;such as vomiting or diarrhea <a class="elsevierStyleCrossRef" href="#bib0175">&#91;16&#93;</a>&#46; Nevertheless&#44; majority of prognostic factors following mushroom intoxication refer to <span class="elsevierStyleItalic">A&#46; phalloides</span> poisoning&#46; In comparison however there is less known about <span class="elsevierStyleItalic">G&#46; esculenta</span> poisoning to help with prognostication&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In summary&#44; <span class="elsevierStyleItalic">G&#46; esculenta</span> poisoning represents a rare but potentially dangerous clinical scenario that should always be considered in the spring time in regions it is found&#46; Given the limited sensitivity and specificity of currently available prognostic criteria&#44; such patients should preferably be transferred to liver transplant and hepatology units early&#46; Efforts should be made to develop more precise and sensitive prognostic criteria that could help clinicians in selecting the patients for liver transplantation&#46;<span class="elsevierStyleDefList"><span class="elsevierStyleSectionTitle" id="sect0040">Abbreviations</span><span class="elsevierStyleDefTerm">ACLF</span><span class="elsevierStyleDefDescription"><p id="par0080" class="elsevierStylePara elsevierViewall">acute-on-chronic liver failure</p></span><span class="elsevierStyleDefTerm">ALF</span><span class="elsevierStyleDefDescription"><p id="par0085" class="elsevierStylePara elsevierViewall">acute liver failure</p></span><span class="elsevierStyleDefTerm">ALI</span><span class="elsevierStyleDefDescription"><p id="par0090" class="elsevierStylePara elsevierViewall">acute liver failure</p></span><span class="elsevierStyleDefTerm">INR</span><span class="elsevierStyleDefDescription"><p id="par0095" class="elsevierStylePara elsevierViewall">international normalized ratio</p></span><span class="elsevierStyleDefTerm">GABA</span><span class="elsevierStyleDefDescription"><p id="par0100" class="elsevierStylePara elsevierViewall">gamma-aminobutyric acid</p></span><span class="elsevierStyleDefTerm">MMH</span><span class="elsevierStyleDefDescription"><p id="par0105" class="elsevierStylePara elsevierViewall">monomethylhydrazine</p></span></span></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">Nothing to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres1199047"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1117487"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case 1 &#8211; acute liver injury"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Case 2 &#8211; acute liver failure"
        ]
        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Case 3 &#8211; acute-on-chronic liver failure"
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflict of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-07-28"
    "fechaAceptado" => "2018-11-28"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1117487"
          "palabras" => array:3 [
            0 => "Acute liver failure"
            1 => "Mushroom poisoning"
            2 => "<span class="elsevierStyleItalic">Gyromitra esculenta</span>"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Gyromitra esculenta</span>&#44; also known as &#8220;false morel&#8221; is one of the most poisonous mushrooms&#46; This species is found all over the world&#44; growing in coniferous forest in early spring time&#46; Common manifestation of poisoning includes gastrointestinal symptoms which include varied degrees of liver impairment&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We describe three cases&#58; acute liver injury&#44; acute liver failure and acute-on-chronic liver failure due to <span class="elsevierStyleItalic">G&#46; esculenta</span> poisoning&#46; At admission patients presented with encephalopathy and features of liver failure&#46; Two of them recovered completely following supportive management while the remaining patient who also had preexisting liver disease developed multiorgan failure and subsequently died&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Although a rare occurrence&#44; <span class="elsevierStyleItalic">G&#46; esculenta</span> poisoning should be considered in the differential diagnosis of acute liver failure&#46;</p></span>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1803
            "Ancho" => 2083
            "Tamanyo" => 441218
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; <span class="elsevierStyleItalic">Gyromitra esculenta</span>&#44; &#8220;false morel&#8221;&#46; &#40;b&#41; <span class="elsevierStyleItalic">Morchella esculenta</span>&#44; &#8220;true morel&#8221;&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Normal ranges&#58; AST 5&#8211;40<span class="elsevierStyleHsp" style=""></span>U&#47;L&#59; ALT 7&#8211;56<span class="elsevierStyleHsp" style=""></span>U&#47;L&#59; INR 0&#46;9&#8211;1&#46;3&#59; total bilirubin 0&#46;2&#8211;1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; serum creatinine 0&#46;6&#8211;1&#46;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; encephalopathy grade West Heaven 0&#8211;4&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; ALT&#44; alanine transaminase&#59; AST&#44; aspartate aminotransferase&#59; S&#46;cr&#44; serum creatine&#59; INR&#44; international normalized ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AST IU&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ALT IU&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#46; cr mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bilirubin mg&#47;dL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">INR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Encephalopathy grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Case 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1032&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2248&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Case 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2422&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2657&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Case 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7605&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5183&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dead&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2047871.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A comparison of laboratory features at admission between three cases after <span class="elsevierStyleItalic">Gyromitra esculenta</span> poisoning&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "&#91;1&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mushrooms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Persson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Medicine"
                        "fecha" => "2016"
                        "volumen" => "44"
                        "paginaInicial" => "116"
                        "paginaFinal" => "119"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "&#91;2&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EASL Clinical Practical Guidelines on the management of acute &#40;fulminant&#41; liver failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "European Association for the Study of the Liver"
                            1 => "J&#46; Wendon"
                            2 => "J&#46; Cordoba"
                            3 => "A&#46; Dhawan"
                            4 => "F&#46;S&#46; Larsen"
                            5 => "M&#46; Manns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2016.12.003"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2017"
                        "volumen" => "66"
                        "paginaInicial" => "1047"
                        "paginaFinal" => "1081"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28417882"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861013008001"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "&#91;3&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American Association for the Study of Liver D AASLD position paper&#58; the management of acute liver failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Polson"
                            1 => "W&#46;M&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.20703"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2005"
                        "volumen" => "41"
                        "paginaInicial" => "1179"
                        "paginaFinal" => "1197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15841455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "&#91;4&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mistaken mushroom poisonings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;H&#46; Diaz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.wem.2015.12.015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Wilderness Environ Med"
                        "fecha" => "2016"
                        "volumen" => "27"
                        "paginaInicial" => "330"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27085814"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "&#91;5&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Montagnese"
                            1 => "A&#46; Biancardi"
                            2 => "S&#46; Schiff"
                            3 => "P&#46; Carraro"
                            4 => "V&#46; Carl&#224;"
                            5 => "G&#46; Mannaioni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.24043"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2011"
                        "volumen" => "53"
                        "paginaInicial" => "558"
                        "paginaFinal" => "566"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21274876"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "&#91;6&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early indicators of prognosis in fulminant hepatic failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;G&#46; O&#8217;Grady"
                            1 => "G&#46;J&#46; Alexander"
                            2 => "K&#46;M&#46; Hayllar"
                            3 => "R&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1989"
                        "volumen" => "97"
                        "paginaInicial" => "439"
                        "paginaFinal" => "445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2490426"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "&#91;7&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Auerbach&#39;s wilderness medicine e-book"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;S&#46; Auerbach"
                            1 => "T&#46;A&#46; Cushing"
                            2 => "N&#46;S&#46; Harris"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2016"
                        "editorial" => "Elsevier Health Sciences"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "&#91;8&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poisoning due to raw <span class="elsevierStyleItalic">Gyromitra esculenta</span> &#40;false morels&#41; west of the Rockies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;M&#46; Leathem"
                            1 => "T&#46;J&#46; Dorran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "CJEM"
                        "fecha" => "2007"
                        "volumen" => "9"
                        "paginaInicial" => "127"
                        "paginaFinal" => "130"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17391587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "&#91;9&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Syndromic diagnosis and management of confirmed mushroom poisonings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;H&#46; Diaz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "33"
                        "paginaInicial" => "427"
                        "paginaFinal" => "436"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15699849"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0022399911001693"
                          "estado" => "S300"
                          "issn" => "00223999"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "&#91;10&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;A&#46; Vale"
                            1 => "S&#46;M&#46; Bradberry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2016"
                        "paginaInicial" => "63"
                        "paginaFinal" => "85"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "&#91;11&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute hepatotoxicity following ingestion of <span class="elsevierStyleItalic">Gyromitra esculenta</span> &#40;false morel&#41; mushrooms"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Balterowich"
                            1 => "B&#46; Blaney"
                            2 => "S&#46; White"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Toxicol Clin Toxicol"
                        "fecha" => "1996"
                        "volumen" => "34"
                        "paginaInicial" => "602"
                        "itemHostRev" => array:3 [
                          "pii" => "S1525861015003072"
                          "estado" => "S300"
                          "issn" => "15258610"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "&#91;12&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of fatal poisoning by <span class="elsevierStyleItalic">Gyromitra esculenta</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;V&#46; Giusti"
                            1 => "A&#46; Carnevale"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Toxicol"
                        "fecha" => "1974"
                        "volumen" => "33"
                        "paginaInicial" => "49"
                        "paginaFinal" => "54"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4480349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "&#91;13&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Poisoning by <span class="elsevierStyleItalic">Gyromitra esculenta</span> &#8211; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Michelot"
                            1 => "B&#46; Toth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Appl Toxicol"
                        "fecha" => "1991"
                        "volumen" => "11"
                        "paginaInicial" => "235"
                        "paginaFinal" => "243"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "&#91;14&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "On the occurrence of N-methyl-N-formylhydrazones in fresh and processed false morel&#44; <span class="elsevierStyleItalic">Gyromitra esculenta</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Pyysalo"
                            1 => "A&#46; Niskanen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Agric Food Chem"
                        "fecha" => "1977"
                        "volumen" => "25"
                        "paginaInicial" => "644"
                        "paginaFinal" => "647"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/558239"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "&#91;15&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer induction in mice by feeding the raw false morel mushroom <span class="elsevierStyleItalic">Gyromitra esculenta</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; Toth"
                            1 => "K&#46; Patil"
                            2 => "H&#46; Pyysalo"
                            3 => "C&#46; Stessman"
                            4 => "P&#46; Gannett"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer Res"
                        "fecha" => "1992"
                        "volumen" => "52"
                        "paginaInicial" => "2279"
                        "paginaFinal" => "2284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1559231"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "&#91;16&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute liver injury and acute liver failure from mushroom poisoning in North America"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;J&#46; Karvellas"
                            1 => "H&#46; Tillman"
                            2 => "A&#46;A&#46; Leung"
                            3 => "W&#46;M&#46; Lee"
                            4 => "M&#46;L&#46; Schilsky"
                            5 => "B&#46; Hameed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/liv.13080"
                      "Revista" => array:6 [
                        "tituloSerie" => "Liver Int"
                        "fecha" => "2016"
                        "volumen" => "36"
                        "paginaInicial" => "1043"
                        "paginaFinal" => "1050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26837055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "&#91;17&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "<span class="elsevierStyleItalic">Amanita phalloide</span>s poisoning&#58; reassessment of prognostic factors and indications for emergency liver transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Escudie"
                            1 => "C&#46; Francoz"
                            2 => "J&#46;P&#46; Vinel"
                            3 => "R&#46; Moucari"
                            4 => "M&#46; Cournot"
                            5 => "V&#46; Paradis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2006.10.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2007"
                        "volumen" => "46"
                        "paginaInicial" => "466"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17188393"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "&#91;18&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Indication of liver transplantation following amatoxin intoxication"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Ganzert"
                            1 => "N&#46; Felgenhauer"
                            2 => "T&#46; Zilker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jhep.2004.10.023"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hepatol"
                        "fecha" => "2005"
                        "volumen" => "42"
                        "paginaInicial" => "202"
                        "paginaFinal" => "209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15664245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "&#91;19&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute liver failure caused by mushroom poisoning&#58; a case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Erden"
                            1 => "K&#46; Esmeray"
                            2 => "H&#46; Karagoz"
                            3 => "S&#46; Karahan"
                            4 => "H&#46;H&#46; Gumuscu"
                            5 => "M&#46; Basak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/IMCRJ.S53773"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Med Case Rep J"
                        "fecha" => "2013"
                        "volumen" => "6"
                        "paginaInicial" => "85"
                        "paginaFinal" => "90"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24294010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16652681/0000001800000003/v2_201906020907/S1665268119300420/v2_201906020907/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "77718"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001800000003/v2_201906020907/S1665268119300420/v2_201906020907/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119300420?idApp=UINPBA00004N"
]

Article information

ISSN: 16652681
Original language: English

DOI:10.1016/j.aohep.2018.11.009

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	11	0	11
2024 October	41	5	46
2024 September	66	4	70
2024 August	54	3	57
2024 July	55	9	64
2024 June	50	3	53
2024 May	65	5	70
2024 April	63	5	68
2024 March	121	18	139
2024 February	84	6	90
2024 January	51	2	53
2023 December	66	6	72
2023 November	54	12	66
2023 October	85	4	89
2023 September	51	5	56
2023 August	63	6	69
2023 July	54	21	75
2023 June	75	2	77
2023 May	136	13	149
2023 April	128	4	132
2023 March	99	8	107
2023 February	72	6	78
2023 January	66	11	77
2022 December	77	9	86
2022 November	161	9	170
2022 October	112	11	123
2022 September	159	13	172
2022 August	151	18	169
2022 July	162	19	181
2022 June	98	12	110
2022 May	107	13	120
2022 April	189	19	208
2022 March	312	39	351
2022 February	327	23	350
2022 January	320	38	358
2021 December	288	40	328
2021 November	317	40	357
2021 October	358	26	384
2021 September	328	35	363
2021 August	318	22	340
2021 July	346	29	375
2021 June	228	22	250
2021 May	316	43	359
2021 April	778	57	835
2021 March	494	41	535
2021 February	321	32	353
2021 January	311	24	335
2020 December	282	30	312
2020 November	271	34	305
2020 October	238	27	265
2020 September	306	28	334
2020 August	263	26	289
2020 July	239	23	262
2020 June	255	29	284
2020 May	217	19	236
2020 April	153	20	173
2020 March	100	10	110
2020 February	49	5	54
2020 January	39	4	43
2019 December	41	4	45
2019 November	16	4	20
2019 October	15	0	15
2019 September	22	4	26
2019 August	11	3	14
2019 July	15	12	27
2019 June	20	24	44
2019 May	21	22	43

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter