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Home Books Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e

Chapter 219: Mushroom Poisoning

Anne F. Brayer; Lynette Froula

INTRODUCTION AND EPIDEMIOLOGY

Mushrooms are a common toxic exposure, with >6600 poisonous mushroom exposures and six deaths reported to poison control centers in 2012 and more than half occurring in children <6 years of age.1

Fortunately, the majority of reported mushroom exposures have a benign outcome.2,3 To prevent mushroom poisoning, avoid eating wild mushrooms. There are no easily recognizable differences between nonpoisonous and poisonous mushrooms. Mushroom toxins are not heat labile and so are not destroyed or deactivated by cooking, canning, freezing, drying, or other means of food preparation.

Depending on the type of mushroom, adverse effects from ingestion range from mild GI symptoms to major cytotoxic effects resulting in organ failure and death. Toxicity varies based on the amount ingested, the age of the mushroom, the season, the geographic location, and the way in which the mushroom was prepared prior to ingestion. One person may show significant effects, whereas others may be asymptomatic after ingesting the same mushroom (Table 219-1).

TABLE 219-1Mushrooms: Symptoms, Toxicity, and Treatment
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TABLE 219-1 Mushrooms: Symptoms, Toxicity, and Treatment
Symptoms Mushrooms Toxicity Treatment
GI symptoms
Onset <2 h

Chlorophyllum molybdites

Omphalotus illudens

Cantharellus cibarius

Amanita caesarea

 Nausea, vomiting, diarrhea (occasionally bloody)

IV hydration

Antiemetics
Onset 6–24 h

Gyromitra esculenta

Amanita phalloides, Amanita bisporigera

Initial: nausea, vomiting, diarrhea

Day 2: rise in AST, ALT levels

Day 3: hepatic failure

IV hydration, glucose; monitor AST, ALT, bilirubin, BUN, and creatinine levels, prothrombin time, partial thromboplastin time

For Amanita: activated charcoal

Consider penicillin G, 300,000–1,000,000 units/kg/d

Silymarin, 20–40 milligrams/kg/d

Consider cimetidine, 4–10 grams/d

Consider hyperbaric oxygen therapy

Muscarinic syndrome

  Onset <30 min

Inocybe

Clitocybe

 SLUDGE syndrome (salivation, lacrimation, urination, defecation, GI hypermotility, and emesis) Supportive; atropine, 0.01 milligram/kg, repeated as needed for severe secretions

CNS excitement

  Onset <30 min

Amanita muscaria

Amanita pantherina

 Intoxication, dizziness, ataxia, visual disturbances, seizures, tachycardia, hypertension, warm dry skin, dry mouth, mydriasis (anticholinergic effects) Supportive; sedation with diazepam, 0.1 milligram/kg IV for children; diazepam, 2–5 milligrams IV, or phenobarbital, 30 milligrams IV for adults

Hallucinations

  Onset <30 min

Psilocybe

Gymnopilus

 Visual hallucinations, ataxia Supportive; sedation with diazepam, 0.1 milligram/kg or 5 milligrams IV for adults, or phenobarbital, 0.5 milligram/kg or 30–60 milligrams IV for adults

Disulfiram reaction

  2–72 h after mushroom, and <30 min after alcohol

 Coprinus Headache, flushing, tachycardia, hyperventilation, shortness of breath, palpitations

Supportive; IV hydration

β-Blockers for supraventricular tachycardia

Norepinephrine for refractory hypotension

Dermatitis

  1–2 d after ingestion

 Shiitake Whip-like, linear, erythematous wheals, blanching erythematous patches, scattered petechiae, pruritus Oral antihistamines, 0.1% triamcinolone ointment twice daily; spontaneously resolves within 1–3 wk

Abbreviations: ALT = alanine aminotransferase; AST = aspartate aminotransferase.

Mushroom toxicity is divided into early toxicity (within 2 hours after ingestion) and delayed toxicity (6 hours to 20 days later).

Mushroom ...

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