Inocybe

Background

Inocybe geophylla

• Genus of potentially poisonous mushroom
• Many species contain muscarine, a toxin that causes cholinergic symptoms
• Rare species contain the hallucinogenic psilocybin

Clinical Features

• Symptoms usually start within 0.5-2hrs and resolve within 12hrs
• Muscarine
  • SLUDGE(M) syndrome (hyperperistalsis)
    • Salivation, Lacrimation, Urination, Diarrhea, GI pain, Emesis, Miosis
  • Bradycardia
  • Miosis
  • Bronchorrhea / Bronchospasm
  • Sweating
  • Vasodilation
• Psilocybin
  • Sensory/psychiatric
    • Euphoria, visual hallucinations, synesthesia
    • Lethargy, depression, anxiety, agitation
    • Confusion, disorientation
  • Sympathetic effects
    • Mydriasis
    • Tachycardia, hypertension

Differential Diagnosis

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

SLUDGE Syndrome

• Carbamate toxicity
• Mushroom toxicity, especially:
  • Amanita muscaria
  • Inocybe
  • Clitocybe
• Organophosphate toxicity
• Nerve agent
  • Sarin
  • VX
  • Novichok agent
• Nicotine toxicity (look alike)
• Acetylcholinesterase inhibitor overdose (e.g in myasthenia gravis or post anesthesia reversal)

Evaluation

• Clinical diagnosis
• Evaluate for alternative etiology of symptoms

Management

• Atropine PRN for muscarinic symptoms
• Supportive care, benzos for unpleasant psilocybin symptoms

See Also

• Mushroom toxicity