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For further information, see CMDT Part 38-47: Mushrooms Poisoning

Key Features

Essentials of Diagnosis

  • Vomiting, diarrhea, and abdominal cramps after ingestion of many different toxic mushrooms

  • Amatoxin-type

    • Delayed-onset severe gastroenteritis, followed by severe hepatic injury

General Considerations

  • There are thousands of toxic mushroom species

  • Ingestion of even a portion of an amatoxin-containing mushroom may be sufficient to cause death

  • Cooking amatoxin-type cyclopeptides does not prevent the poisoning

Clinical Findings

Symptoms and Signs

  • Amatoxin-type cyclopeptides (Amanita phalloides, Amanita ocreata, Amanita verna, Amanita virosa, and Galerina species)

    • After a latent interval of 8–12 h, severe abdominal cramps and vomiting begin and progress to profuse diarrhea

    • Acute kidney injury, hepatic necrosis, and hepatic encephalopathy, occur 1–2 days after onset

  • Gyromitrin type (Gyromitra and Helvella species)

    • Toxicity is more common following ingestion of uncooked mushrooms

    • Vomiting, diarrhea, hepatic necrosis, convulsions, coma, and hemolysis may occur after a latent period of 8–12 h

  • Muscarinic type (Inocybe and Clitocybe species)

    • Vomiting, diarrhea, bradycardia, hypotension, salivation, miosis, bronchospasm, and lacrimation occur shortly after ingestion

    • Cardiac arrhythmias may occur

  • Anticholinergic type (Amanita muscaria, Amanita pantherina)

    • Excitement

    • Delirium

    • Flushed skin

    • Dilated pupils

    • Muscular jerking tremors

  • Gastrointestinal irritant type (Boletus, Cantharellus)

    • Nausea, vomiting, and diarrhea occur shortly after ingestion

  • Disulfiram type (Coprinus species)

    • Disulfiram-like sensitivity to alcohol may persist for several days

    • Toxicity is characterized by flushing, hypotension, and vomiting after coingestion of alcohol

  • Hallucinogenic (Psilocybe and Panaeolus species)

    • Mydriasis, nausea and vomiting, and intense visual hallucinations occur 1–2 h after ingestion

  • Cortinarius orellanus

    • May cause acute kidney injury due to tubulointerstitial nephritis

Differential Diagnosis

  • Some hallucinogenic plants can produce anticholinergic delirium


  • There are no readily available laboratory tests for mushroom toxins

  • Local mycologist may help identify suspect fungi

  • Amatoxin-type mushrooms

    • Typical delay of 8–12 hours before gastrointestinal symptoms occur

    • Hepatic transaminases elevated after 24 hours

    • Necrosis of the liver, massive and acute

    • Metabolic acidosis, hypoglycemia, elevated ammonia suggest severe hepatic failure




  • Administer activated charcoal (60–100 g orally or via gastric tube, mixed in aqueous slurry) for any recent ingestion

  • Give intravenous fluids to replace losses from vomiting and diarrhea

  • Monitor central venous pressure, urinary output, and kidney function tests to help guide volume replacement

  • After the onset of symptoms, efforts to remove the toxic agent are probably useless, especially in cases of amatoxin or gyromitrin poisoning, in which there is usually a delay of 12 h or more before symptoms occur


  • Amatoxin-type cyclopeptides

    • Aggressive fluid replacement for diarrhea and intensive ...

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