Mushroom toxicity: Difference between revisions
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**Benzos may be given to pts who are agitated | **Benzos may be given to pts who are agitated | ||
**Consider [[pyridoxine]] for refractory seizures, esp if suspecting [[gyromitra]]<ref> Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175. </ref> | **Consider [[pyridoxine]] for refractory seizures, esp if suspecting [[gyromitra]]<ref> Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175. </ref> | ||
*Muscarinic predominant symptoms: | *Muscarinic predominant symptoms: | ||
**Consider atropine for severe symptoms; 0.5-1mg IV for adults; 0.01mg/kg IV for peds | **Consider atropine for severe symptoms; 0.5-1mg IV for adults; 0.01mg/kg IV for peds | ||
Revision as of 04:23, 9 June 2016
Background
Major Categories
- Early-Onset Poisoning
- Toxicity begins within 2hr of ingestion; clinical course is usually benign
- Late-Onset Poisoning
- Toxicity begins 6hr after ingestion; clinical course is often serious/ possibly fatal
Mushroom toxicity by Type
| Mushroom | Toxin | Pathologic Effect |
| Amanita | Amatoxin | Hepatotoxicity |
| Coprine | Disulfiram-like | |
| Crotinarius | Orellanine | Delayed renal failure |
| Gyromitra | Gyromitrin | Seizures |
| Ibotenic Acid | Anticholinergic | |
| Muscarine | Cholinergic | |
| Orellanin | Nephrotoxicity | |
| Psilocybin | Hallucinations |
Differential Diagnosis
Causes of acute hepatitis
- Acetaminophen toxicity (most common cause of acute liver failure in the US[1])
- Viral hepatitis
- Toxoplasmosis
- Acute alcoholic hepatitis
- Toxins
- Ischemic hepatitis
- Autoimmune hepatitis
- Wilson's disease
Diagnosis
Early-Onset Poisoning
- Comprises majority of mushroom-induced intoxications
- Symptom onset 30-90 min with hallucinations, lasting 6-8 hrs[2]:
- Isoxazoles (ibotenic acid and muscimol) - dsyarthria, ataxia, muscle cramps
- Psilocybin - euphoria, visual hallucinations, agitation, sympathomimetic Sxs
Clinical Features
- Depends on the type of mushroom ingested
- GI
- Nausea/vomiting/diarrhea
- Resolves within 24hr
- CNS
- Euphoria, hallucinations
- Lasts 4-6hr
- Muscarinic
- SLUDGE symptoms
- Diaphoresis, muscle fasciculations, miosis, bradycardia, bronchorrhea
- Resolves in 4-12hr
- Disulfiram-like effect
- Usually when drinking alcohol
- Flushing, tachycardia, diaphoresis, hypotension
Treatment
- GI predominant symptoms:
- Activated charcoal 0.5-1gm/kg
- Do not give antidiarrheal meds
- CNS predominant symptoms:
- Place in dark, quiet room
- Benzos may be given to pts who are agitated
- Consider pyridoxine for refractory seizures, esp if suspecting gyromitra[3]
- Muscarinic predominant symptoms:
- Consider atropine for severe symptoms; 0.5-1mg IV for adults; 0.01mg/kg IV for peds
Disposition
- Discharge once symptoms have subsided
Delayed-Onset Poisoning
- Amanita species causes 95% of deaths
- Toxin inhibits formation of mRNA and is heat stable
- Most frequent species: A. phalloides, bisporigera, magnivelaris, ocreata, verna, virosa[4]
References
- ↑ Ostapowicz G, Fontana RJ, Schiodt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec 17; 137(12): 947-54.
- ↑ Rolston-Cregler L et al. Hallucinogenic Mushroom Toxicity. Apr 08, 2015. http://emedicine.medscape.com/article/817848-overview.
- ↑ Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175.
- ↑ Enjalbert F et al. Treatment of Amatoxin Poisoning: 20 year retrospective analysis. J tox Clin Tox 2002 40(6):715-767.