Psilocybin toxicity

Background

Psilocybe semilanceata

A compound found in over 200 mushrooms that has mind altering properties similar to LSD. Commonly known as "magic mushrooms" or "shrooms". The mushroom are often taken recreationally for the euphoric and hallucinogenic effects. Typically grown in the Pacific Northwest and southern regions of the United States. For a typical dose (1mg) symptoms will last 1-3 hours.

Toxicity

• Low
• 280mg/kg
• Therapeutic index of 641

Clinical Features

• Sensory/psychiatric
  • Euphoria
  • Visual hallucinations, synesthesia
  • Lethargy, Depression
  • Anxiety, agitation
  • Confusion, disorientation
  • Above may lead to accidental trauma
• Sympathetic effects
  • Mydriasis
  • Tachycardia
  • Hypertension
• Nausea
• Hypotension

Differential Diagnosis

• Hypoglycemia
• TBI
• CO poisoning
• Meningitis/Encephalitis
• Opioid intoxication
• Antihistamines/Anticholinergic toxicity

Drugs of abuse

• 25C-NBOMe‎
• Alcohol
• Amphetamines
• Bath salts
• Cocaine
• Ecstasy
• Gamma hydroxybutyrate (GHB)
• Heroin
• Inhalant abuse
  • Hydrocarbon toxicity
  • Difluoroethane (electronics duster)
• Marijuana
• Kratom
• Phencyclidine (PCP)
• Psilocybin ("magic mushrooms")
• Synthetic cannabinoids
• Chloral hydrate
• Body packing

Evaluation

• Clinical diagnosis
• Urine drug screen if concerned about co-ingestion

Management

• Supportive care
• Place patient in a calm and quiet environment
• Benzodiazepines for worsening tachycardia/hypertension or agitation

Disposition

• Discharge when vitals normalize and clinically sober

See Also

• Mushroom toxicity
• Drugs of abuse

References

• Nichols DE. Hallucinogens. Pharmacol Ther 2004; 101:131.
• UpToDate
• van Amsterdam J, Opperhuizen A, van den Brink W (2011). "Harm potential of magic mushroom use: a review" (PDF). Regulatory Toxicology and Pharmacology. 59 (3): 423–9. doi:10.1016/j.yrtph.2011.01.006. PMID 21256914.
• Merck Index, 11th Edition, 7942
• "Comparison of acute lethal toxicity of commonly abused psychoactive substances" (PDF). Addiction. 99 (6): 686–96. doi:10.1111/j.1360-0443.2004.00744.x. PMID 15139867.
• Passie T, Seifert J, Schneider U, Emrich HM (2002). "The pharmacology of psilocybin". Addiction Biology. 7 (4): 357–64. doi:10.1080/1355621021000005937. PMID 14578010.
• "Comparison of acute lethal toxicity of commonly abused psychoactive substances" (PDF). Addiction. 99 (6): 686–96. doi:10.1111/j.1360-0443.2004.00744.x. PMID 15139867.
• Halpern JH1. "Hallucinogens and dissociative agents naturally growing in the United States." Pharmacol Ther. 2004 May;102(2):131-8.