The letter by Olson and colleagues aptly points out that some instances of mushroom poisoning are caused by mixed mushroom ingestion and that early symptoms caused by mushrooms of low toxicity could mask later, more serious manifestations caused by amatoxins. This possibility again emphasizes that mushrooms involved in poisonings must be promptly and accurately identified and that the patient's fluid, electrolyte, and acid-base status requires careful monitoring until recovery is complete.We disagree that the use of thioctic acid and some other agents represents a "grab bag" approach to treatment of amatoxin poisoning and feel that their characterization of these therapies as "antidotes" is misleading. Our article stressed that intensive supportive care is the principal therapy for amatoxin poisoning and that the efficacy of thioctic acid has not been proved by controlled clinical trials. Nonetheless, numerous reports in the European and American literature, including an earlier report from
Hanrahan JP, Gordon MA. Treatment of Mushroom Poisoning-Reply. JAMA. 1984;252(22):3131–3132. doi:10.1001/jama.1984.03350220038024
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