毒理性
◉ 母乳喂养期间的使用总结：鹅膏毒肽是一类水溶性、热稳定的肽类，存在于鹅膏属（最常见的是鹅膏蕈）、鹅膏环柄菇属和某些鳞伞属物种中。从鹅膏蕈中提取的主要毒素是alpha-amanitin，一种环状八肽。它是一种强烈的RNA聚合酶抑制剂，可以阻止肝脏和肾脏细胞中mRNA的产生和蛋白质合成。在一个案例中，一位母亲食用鹅膏蕈后11.5小时哺乳一次，婴儿出现肝酶升高。然而，最近两个详细记录的案例发现哺乳婴儿没有不良反应，乳汁中没有鹅膏毒肽。尽管如此，疑似食用鹅膏蕈中毒的母亲在恢复之前或对母乳进行毒理学筛查排除之前，可能不应该哺乳。
◉ 对哺乳婴儿的影响：在德国，一位20岁的哺乳母亲吃了一顿仅由蘑菇组成的餐食，报告将其识别为绿色块菌（鹅膏蕈）。蘑菇摄入后的第二天早上大约11.5小时，她给她的10周大，体重5公斤的婴儿喂奶。这顿饭包括80到100毫升的母乳和同样数量的即食婴儿配方奶粉（MiLAsan-Neu）。此时，母亲已经出现中毒症状（呕吐和腹泻）。由于病情恶化，她无法继续哺乳孩子，所以孩子之后只接受了配方奶粉。母亲因鹅膏蕈中毒被送往医院，其ASAT和ALAT值分别为10,000和40,000（正常值约为500-550）。婴儿被送往儿童医院接受住院观察。婴儿的亲属没有注意到孩子有任何不寻常的地方，临床入院检查也没有发现明显的肝脏、大脑或血液疾病的迹象。母亲食用蘑菇后6天，婴儿的实验室检查值（电解质、血清电泳、胆红素、gamma-GT、碱性磷酸酶、肌酐、血糖、尿液状态、PTT和PT[快速测试]）都正常，除了ASAT和ALAT大约是正常值的两倍。这些值在摄入后大约40天逐渐下降并恢复正常。
一位32岁的母亲与家人共享了一顿采摘的蘑菇（Amanita bisporigera）大餐，摄入后15小时出现症状。她在摄入后29小时到急诊科就诊，被发现肝酶显著升高。她4个月大的女儿在摄入后4小时哺乳。哺乳后48小时评估的无症状婴儿从急诊科出院，没有肝毒性的证据。
一位33岁的妇女在法国的森林里采摘了大约200个蘑菇。她烹饪并食用了一些，摄入后11小时出现恶心、呕吐和腹泻。她因治疗被送往医院，肝酶升高。她在蘑菇摄入后的36小时内，每天三次给5个月大的女儿哺乳。她的女儿被住院，但没有出现任何症状或生物学干扰。
◉ 对泌乳和母乳的影响：截至修订日期，没有找到相关的已发布信息。
◉ Summary of Use during Lactation:Amatoxins are water soluble, heat stable polypeptides found in Amanita (most often Amanita phalloides ), Galerina and some Lepiota species. The main toxin from the species A. phalloides is alpha-amanitin, a cyclic octapeptide. It is a potent inhibitor of RNA polymerases that blocks the production of mRNA and protein synthesis in liver and kidney cells. In one case, an infant developed elevated liver enzymes after nursing once 11.5 hours after maternal ingestion of Amanita phalloides. However, two recent, well-documented cases found no adverse effects in breastfed infants and no amatoxin in the milk. Nevertheless, mothers suspected of having Amanita mushroom poisoning probably should not breastfeed until they have recovered or toxicologic screening of the breastmilk has ruled out.
◉ Effects in Breastfed Infants:In Germany, a 20-year-old nursing mother ate a meal of solely mushrooms identified in the report as green tuberous mushroom (Amanita phalloides). The next morning around 11.5 hours after mushroom ingestion, she nursed her 10-week-old infant who weighed 5 kg. The meal consisted of 80 to 100 mL of breastmilk and the same amount of ready-to-use infant formula (Milasan-Neu). At this time the mother already had symptoms of intoxication (vomiting and diarrhea). Because of the deterioration in her condition she was unable to continue breastfeeding the child, so the child received only formula thereafter. After the mother was admitted to the hospital for Amanita phalloides poisoning and had ASAT and ALAT values of 10,000 and 40,000, respectively (normal values about 500-550). The infant was placed under inpatient observation at children’s hospital. The infant’s relatives noticed nothing unusual about the child and the clinical admission examination revealed no visible evidence of a hepatic, cerebral or hematological disease. Six days after maternal mushroom ingestion, the infant’s laboratory values (electrolytes, serum electrophoresis, bilirubin, gamma-GT, alkaline phosphatase, creatinine, blood sugar, urine status, PTT, and PT [Quick test]) were normal except for ASAT and ALAT, which were about double the normal value. These values slowly decreased and became normal at about day 40 after ingestion.
A 32-year-old mother shared a meal of foraged mushrooms (Amanita bisporigera), and developed symptoms 15 hours post-ingestion. She presented to the emergency department 29 hours post-ingestion and was found to have markedly elevated liver enzymes. Her 4 month-old-daughter had breastfed 4 hours post-ingestion. The asymptomatic infant was evaluated 48 hours after breastfeeding and discharged from the emergency department with no evidence of hepatotoxicity.
A 33-year-old woman picked about 200 mushrooms in a forest in France. She cooked and ate some of them, and developed nausea, vomiting and diarrhea 11 hours post-ingestion. She was admitted to the hospital for treatment and had elevated liver enzymes. She had breastfed her 5-month-old daughter 3 times a day over the 36 hours after mushroom ingestion. Her daughter was hospitalized, but did not present any symptoms, nor any biological disturbance.
◉ Effects on Lactation and Breastmilk:Relevant published information was not found as of the revision date.
来源:Drugs and Lactation Database (LactMed)
