A 42-year-old man presents with severe vomiting and diarrhea 6 hours after consuming foraged wild mushrooms. He initially improves but returns 2 days later with jaundice, abdominal pain, and altered mental status. Vitals show BP 98/62, HR 118, RR 22, temp 37.8°C. Laboratory studies reveal INR 4.2, AST 2,400 U/L, and acute kidney injury. Notably, he denies hemoptysis. Which mechanism best explains the responsible toxin's hepatotoxicity?

  1. A)Irreversible inhibition of acetylcholinesterase
  2. B)Activation of ryanodine receptors
  3. C)Blockade of GABA-A receptors
  4. D)Inhibition of RNA polymerase IIGABARITO
  5. E)Chelation of ferric iron

Explicação

Amanita phalloides poisoning is caused by amatoxins, which inhibit RNA polymerase II and can cause delayed fulminant hepatic failure after an initial gastrointestinal phase. The deceptive transient improvement is a classic clue. Ver explicação completa e trilha adaptativa →

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