Clinical Analysis Of 53 Cases Of Hospitalized Children With Mushroom Poisoning

Background: PM,poisonous mushroom.Over the past few decades,mushrooms have become popular in peoples' daily diets because of their delicate taste and unique nutritional value.With an increasing public demand for wild edible mushrooms,followed by an increasing interest in their harvesting,the incidence of poisoning which caused by pickers confusion of edible and poisonous mushroom happens occasionally.The clinical manifestations of poisonous mushroom poisoning(PMP)are complex and diverse.The initial symptoms are usually non-specific,and the first symptom and prognosis are usually not directly related.PMP can cause damage to one or more organs such as the liver and kidney.In severe cases,it can progress to multiple organ dysfunction syndrome(MODS)and result to death.Children as a special group,poor tolerance to toxins leads to poorer prognosis.Therefore,the management and risk assessment of PMP is a challenge for pediatric emergency doctors.Detailed clinical analysis can help guide clinical decision making,but there are fewer detailed clinical analysis of PMP in children at home and abroad.Objective:To study the clinical features,prognostic factors and the improvement of visceral injury markers in children with PMP in order to improve the pediatrician's understanding and diagnosis of PMP.Methods: Data of 53 PMP hospitalized children from January 2003 to December 2017 in Hunan Provincial Children's Hospital were retrospectively analyzed:(1)Collected the data of 53 children,including their age,gender,onset time,poisoning season,place of residence,time of occurrence of clinical symptoms,time of hospitalization,clinical symptoms,laboratory test results,organ damage,treatment conditions and outcome,etc.They were divided into good-prognosis group or poor-prognosis group according to the varying treatment outcomes.A statistical analysis was performed on the relevant clinical data of the two groups of children,so as to study the prognostic factors of PMP children.(2)According to different treatment methods for children with PMP,they were divided into routine treatment group(18 cases),single blood purification group(18 cases)and combined blood purification group(17 cases).The blood purification group was treated with conventional treatment and blood purification treatment,single blood purification group includes hemoperfusion(HP)or continuous blood purification(CBP).The combined blood purification includes continuous blood purification(CBP)combined with one or two method of hemoperfusion(HP)and plasma exchange(PE).The changes of total bilirubin(TB),aspartate aminotransferase(AST),alanine aminotransferase(ALT),prothrombin time(PT),activated partial thromboplastin time(APTT),blood urea nitrogen(BUN),serum creatinine(Scr)were observed before and after treatment in the three groups of children.to evaluate the improvement of viscera injury index of PMP children.All data of this study were input by excel table and analyzed by SPSS18.0 software.When P<0.05,it has statistically significanc.The counting data were expressed in frequency and rate,and measurement data that did not obey the normal distribution were presented as median and quarter points [P50(P25,P75)].The Wilcoxon signed rank test was used for the comparison between the two groups and the Wilcoxon two-sample comparison method was used for the measurement data not obeying normal distribution or population variance irregularity.The ?2 test was used for the comparison between two groups,As to the univariate analysis and prognosis-related indicators,the statistically significant indicators and the prognosis were analyzed by two-class logistic regression analysis.The index that closely related to prognosis,we make the ROC curve,and an area under the curve>70% was defined as good prognosis discrimination.Results:(1)The age of children ranged from 1.3 to 12.3(median age 5.6)years old,including 32 males(60.4%)and 21 females(39.6%).The onset time was from January 2003 to December 2007 in 3 cases,from January 2008 to December 2012 in 16 cases,from January 2013 to December 2017 in 34 cases.Summer and autumn had the highest incidence,accounting for 54.7 % and 35.8 % respectively.43 poisoned children from rural areas and 10 from urban areas.The first three most common symptoms were vomiting(86.8%),abdominal pain(50.9%),and diarrhea(47.2%).26 cases had symptoms less than 6 hours(early onset)and 27 cases more than or equal to 6 hours(late onset)after PM administration.10 patients were treated with PM within 6 hours,25 patients within 6 hours to 24 hours,and 18 patients over 24 hours.The results of laboratory examination(the first time after admission)showed that there were 29 patients with WBC elevation(54.7%),5 patients with CRP elevation(9.4%),30 patients with AST elevation(56.6%),28 patients with ALT elevation(52.8%),21 patients with TB elevation(39.6%),19 patients with ammonia elevation(35.8%),27 patients with PT elevation(50.9%),19 patients with APTT elevation(35.8%),11 patients with Scr elevation(20.8%),8 patients with BUN elevation(15.1%),13 patients with CK elevation(24.5%),12 patients with CK-MB elevation(22.6%)and 27 patients with LDH elevation(50.9%).Organ damage include 31 cases of toxic hepatitis(58.5%),27 case of coagulation dysfunction(50.9%),19 cases of toxic encephalopathy(35.8%),12 cases of toxic myocarditis(22.6%),11 cases of renal failure(20.8%),17 case of combined organ damage(32.1%),11 cases of combined two organ damage(20.8%),25 cases of combined three or more organ damage(47.2%),44 cases of good prognosis(83.0%)and 9 cases of poor prognosis(17.0%).(2)Comparison of related data between patients with good prognosis and poor prognosis:The results showing that there were significant differences between the two groups(P<0.05)in the time from PM consumption to symptoms,to hospitalization,consciousness disturbance,organ damage,WBC,AST,ALT,TB,ammonia,PT,CK-MB,LDH.Among which AST was closely related to prognosis(P<0.05).The OR value was 2.945.The area under the ROC curve of AST for distinguishing prognosis was 0.859,and the boundary was 765.60 IU/L.The best sensitivity and specificity were 0.889 and 0.773.(3)Improvement of visceral injury index in PMP children after treatment in each group: Continuous blood purification(CBP)combined with one or two of hemoperfusion(HP)and plasma exchange(PE)can reduce TB,AST,ALT,PT,APTT,BUN,and Scr,the difference between before and after treatment was statistically significant(P<0.05).Hemoperfusion(HP)or continuous blood purification(CBP)treatment alone can reduce TB,AST,ALT,PT,BUN,the difference between before and after treatment was statistically significant(P<0.05).TB,AST,ALT,PT were decreased in the conventional treatment group,the difference was statistically significant before and after treatment(P<0.05).Conclusion:(1)The clinical manifestations of PMP in children are diverse and can affect multiple organs.The time of onset,time of treatment,conscious disturbance,number of organs involved,WBC,AST,ALT,TB,Ammonia,PT,CK-MB,LDH were correlated with prognosis in PMP children.AST was closely correlated with prognosis,which could be used as a good reference index to judge the prognosis of PMP children.(2)Continuous blood purification(CBP)combined with hemoperfusion(HP)or(and)plasma exchange(PE)can reduce TB,AST,ALT,PT,APTT,BUN,and Scr in PMP children and improve the comprehensive function of liver,kidney and blood coagulation.