Gyromitra mushrooms

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Gyromitra mushrooms
  • Also known as "brain fungi"
  • Fruit in the spring and early summer
  • Frequently mistaken for morel mushrooms[1]
  • Inhibits formation of Vitamin B6 and GABA via hydrazine metabolite (similar to isoniazid toxicity)

Clinical Features

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



  • Blood sugar
  • BMP
  • LFT
  • Coags
  • CBC with differential
  • LDH, haptoglobin, reticulocyte
  • CK
  • MetHb level
  • Urine drug screen
  • Urinalysis


  • Supportive care
  • Dextrose boluses/infusions
  • High dose pyridoxine for refractory seizures (5g IV initially) [4]
  • Avoid phenobarbital, especially in liver failure
  • Methylene blue for severe methemoglobinemia
  • Folinic acid (leucovorin) supplementation (hydrazines inhibit MTHF production)
  • Liver transplant for refractory hepatic failure


See Also


  1. Brozen R et al. Gyromitra Mushroom Toxicity. Apr 14, 2015.
  2. Tomková J, Ondra P, Válka I. Simultaneous determination of mushroom toxins α-amanitin, β-amanitin and muscarine in human urine by solid-phase extraction and ultra-high-performance liquid chromatography coupled with ultra-high-resolution TOF mass spectrometry. Forensic Sci Int. 2015 Jun. 251:209-13.
  3. Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005 Feb. 33(2):427-36.
  4. Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175.