Continued: California family nearly makes fatal mushroom mistake

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The twins were diagnosed with inflammation of the pancreas and liver damage. The hospital prepared for the possibility that the boys would need liver transplants.

Doctors initially had difficulty identifying the specific culprit. The boys' mother returned to the site where the mushrooms were picked. An expert with the Mycological Society of San Francisco - which offers mushroom walks and workshops - helped identify the culprit as Amanita phalloides.

"Ithaca does not have aminitas," Elbert said. "They were scattered under the live oaks with many, many other kinds of mushrooms."

Dr. Kent Olson, the medical director of the San Francisco division of the California Poison Control System, said the death cap is "extremely potent in very small quantities."

Doctors used an arsenal of several different medications to attack the poison, including penicillin and acetylcysteine - but there is no known antidote for this toxin.

Doctors also obtained a waiver from the U.S. Food and Drug Administration for an organic compound, milk thistle derived silimarin, which was air-freighted to the hospital from Germany.

"It's hard to know within the first 24 to 48 hours who is going to make a recovery or who is going to need a transplant - and who may progress to death," said Dr. Sue Rhee, a pediatric gastroenterologist at UCSF Children's Hospital.

E-mail Jim Doyle at jdoyle(at)sfchronicle.com.

(Distributed by Scripps Howard News Service, http://www.scrippsnews.com.)

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