Amatoxin containing mushrooms are a rare but significant cause of acute fulminant liver failure. However, not all Amanita species have this toxin, and other mushroom species besides Amanita have the amatoxin. (Table) Ninety-five percent of deaths from mushroom ingestions worldwide are from...
www.ncbi.nlm.nih.gov
There is a part about the mechanism of amatoxin effects.
But if I understood this article correctly, liver failure, although fulminant, usually develops in phase II. Some people may not survive into phase II, and in phase I one would see, first, whole body effects. In ingested poisons, GI ones.
Let me give another example: thallium, another horrible poison which is used in rhodenticides and ant-killers, is described by Agatha Christie. In her story, the main symptom was hair loss. Alopecia in thallium poisoning develops in about two weeks, but that if people live into it. If they die sooner, the symptoms might be only from GI tract + death from collapse. At this phase, it might be yet impossible to guess what poison was used judging by clinical picture. If you are told, we ate mushrooms, you’d probably look for amatoxin first.
Those who survive into phase II of thallium poisoning, will develop neurological symptoms, and this is where the doctors would be able to rule out a lot of poisons, including mushrooms.
What I want to say, a big enough dose of most poisons is expected to cause death within a day. Probably, at that phase doctors would initially see the same symptoms (GI ones, mostly). In this phase, the suspicion about mushrooms might be based on the report “we ate mushrooms”. What, in fact, caused the poisoning, would be yet difficult to diagnose.
It people survive phase I, in phase II, new symptoms would appear, and they might differ between poisons, but yet may not always be specific enough. In phase III, it probably should be very clear what caused the poisoning, but people have to survive into phase III. And sometimes even phase III is not crystal clear (radioactive polonium poisoning in London required autopsy for the diagnosis, for example).
MOO. We think mushrooms because: a) we were told, mushrooms from an Asian market and b) we were told that Ian might need liver transplant. Today, we know that a) mushrooms or not, Asian market was not involved and
b) Ian didn’t need liver transplant. It could mean that Ian was lucky or, that the toxin did not affect his liver.
The information we get from different sources is unbelievably different in this case. It might be so that LE, seeing that EP was an unreliable reporter, decided to use the same strategy with her. If so, it was a very wise decision.