MUSHROOM POISONING

The 50-100 of around 10 000 mushroom species are poisonous

  • Clinical syndrome evaluation is very important because 95% of mushrooms are not identified
  • Ingestion of amanita phalloides is responsible for 95% of fatalities due to mushrooms poisoning
  • Ingestion of the most fatal mushrooms usually have an 8-24Hour delay in symptom onset
  • When symptoms occur after 6 hours it indicates a large toxic exposure and poor prognosis
  • All other species have shorter latency periods-Typically 30minutes to 3hours (˂6 hours).

Management:

  • A primary survey 5ABC) should be performed
  • In amanita phalloides intoxication, a Cholera-Like profuse diarhoea mandates specific attention to intravenous rehydration. Sufficient fluid be given to promote renal clearance of amatoxin.
  • Activated charcoal (1g per kg) should be given, and multi dose activated charcoal should be considered to interrupt entero-hepatic recirculation in amanita phalloides poisoning.
  • Limited evidence supports the use of following 5 antidotes in amanita phalloides poisoning:
  • Multodose activated charcoal(MDAC)
  • Silibinin: Inhibit uptake, Reduction of TNF alpha-mediated apoptosis. Effective in animal studies
  • Penicillin G:Inhibit uptake
  • N-Acetylcystein: may adversely affect clotting profile in severe cases
  • Thiotic acid.
  • Liver transplantation may be indicated as a last resort.
  • Psilocybin containing mushrooms have effects similar to lysergic acid (LSD) and should be managed by providing emotional support until the self-limiting effects end.
  • Benzodiazepines may be helpful to control unpleasant hallucinations
  • Muscarine is present in certain species of clitocybe mushrooms.Treatment is supportive. A dose of atropine is rarely indicated for excessive muscarinic effect (0, 05 MG/kg). This can be repeated every 5 to 10minutes to clear secretions.

 

Poisonous mushroom species with their toxins, symptom onset and clinical picture

Mushroom types Toxin Symptom onset Clinical signs
Amanita phalloides Cyclopeptides

Amatoxin

phallotoxin

6-72hours Gastro-enteritis and profuse diarrhea dehydratation. Honrymoon period prior to hepatic and renal failure
Clitocybe inocybe Mascarine 0,5-3hours Sludge syndrome (Salivation,lacrimation,urination,gastro-enteritis)
Psilocybin mushrooms Psychoactive 0,5-3hours Euphoria,Hallucinations,hypertermia
Psilocybin
LSD like
Coprinus mushroom Disulfiram 0,5-3hours Flushing,palpitations,hyperthermia
Like reaction After alcohol ingestion
Amanita Muscaria Ibotenic acid 0,5-3hours Hallunicinations,delirium,euphoria,tremors
Amanita Pabtherina Muscimol
A variety of small brown mushrooms GI toxins 0,5-3hours Nausea,vomiting,diarrhoea

 

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