Mushroom toxicity
Background
Amatoxin
- inhibits rna polymerase and interfers c dna rna transcriptn. -
- Disruption of protein synthesis causes fatal intestinal hepatic renal dz.
- Is heat stable- not affected by cooking
- delayed tox- 6-24 hrs
- liver and kidney failure
Gyromitrins
- oxidizes hemoglobin- can cause methemoglobinemia
- inhibits glutamic acid decarboxylase- leads to low GABA level - neuro sxs
-delayed 6-8 hrs -
- hepatitis
- cns changes
- hemolysis
- metHb
Orellanine and orelline
Coprine
- if ingested c etoh can lead to Beta adrenergic stimulation like disulfiram rxn
Ibotenic acid and muscimol
- anticholinergic activity and hallucinatns,
Muscarine
- cholinergic stimulatn- blurred vision, sweating, HA, lacrimation, salivation, urinary freq
Psilocybin and psilocin
- nv, hallucination, flashbacks
Diagnosis
- if > 6h from ingestion to sxs suggests amatoxin, gyromitrin, orellenine, oreline. Do LFT, PT
- if < 3h is ibotenic acid, muscimol, muscarine, psilocin
- temporal assoc c etoh and sxs suggest coprine poisoning
Treatment
- charcoal
- no antiemetic or imodium since will cause increased toxin absorption
- golightly whole bowel irrigation
- if amatoxn, gyromitrin, orellanine admit for observatn
TOXIN SPECIFIC TX-
Amatoxn-
- forced diuresis
- charcoal hemoperfusion
- high dose penicilin- inhibits amatoxn uptake by hepatocytes. One million units/kg in divided doses per day for 2- 3 days. Sz is complicatn.
- high dose cimetidine- inhibits P450 enzyme. 2 gms q 4h iv
- liver xplant
- hyperbaric O2
- high dose ascorbic acid
- N- acetylcysteine
Gyromitrin poisoning-
- pyridoxin 25mg/kg iv over 30min. Repeat up to 4 times in 24 hrs if sxs persist.
- benzos
- diuresis
- blood xfusion
- methylene blue
Orellanine
- fluids
Coprine- etoh
- dopamine for hypotn
Ibotenil- muscimol
- control neuromuscular hyperactivity- benzos. Consider physostigmine if refractory agitation and tachy and perif anticholinergic findings
Muscarine poisoning
- atropine
- albuterol
- anti histamines,
Source
6/06 MISTRY