Delayed gastroenteritis and liver failure
Amatoxins (See Mercury)
Amanita phalloides, Amanita ocreata, Amanita verna, Amanita virosa, Amanita bisporigera, Galerina autumnalis, Galerina marginata, and some Lepiota and Conocybe spp
Delayed onset 6–24 hours: vomiting, diarrhea, abdominal cramps, followed by fulminant hepatic failure after 2–3 days.
Delayed gastroenteritis, CNS abnormalities, hemolysis, hepatitis
Gyromitra (Helvella) esculenta, others
Delayed onset 5–8 hours: vomiting, diarrhea, followed by dizziness, weakness, headache, ataxia, delirium, seizures, coma; hemolysis, methemoglobinemia, hepatic and renal injury may also occur.
Clitocybe dealbata, Clitocybe cerrusata, Inocybe cincinnata
Onset 30 minutes–2 hours: diaphoresis, bradycardia, bronchospasm, lacrimation, salivation, sweating, vomiting, diarrhea, miosis. Treat with atropine (See Atropine and Glycopyrrolate).
Disulfiram-like reaction with alcohol
Coprinus atramentarius, Clitocybe claviceps
Within 30 minutes after ingestion of alcohol: nausea, vomiting, flushing, tachycardia, hypotension; risk for reaction for up to 5 days after ingestion of fungi (see “Disulfiram”).
Ibotenic acid, muscimol
Amanita muscaria, Amanita pantherina, others
Onset 30 minutes–2 hours: vomiting, dizziness followed by drowsiness, muscular jerking, hallucinations, delirium, rarely seizures.
Gastritis and renal failure
Amanita smithiana, Amanita proxima
Abdominal pain, vomiting within 30 minutes–12 hours, followed by progressive acute renal failure within 2–3 days. Some elevation in hepatic enzymes may occur.
Delayed-onset gastritis and renal failure
Cortinarius orellanus, other Cortinarius spp
Abdominal pain, anorexia, vomiting starting after 24–36 hours, followed by progressive acute renal failure (tubulointerstitial nephritis) 3–14 days later.
Psilocybe cubensis, panaeolina foenisecii, others
Onset 30 minutes–2 hours: visual hallucinations, sensory distortion, tachycardia, mydriasis, occasionally seizures.
Chlorophyllum molybdites, Boletus satanas, many others
Vomiting, diarrhea within 30 minutes–2 hours of ingestion; symptoms resolve within 6–24 hours.
GI irritant for most, but a few people develop immune-mediated hemolysis within 2 hours of ingestion.
Allergic pneumonitis (inhaled spores)
Inhalation of dry spores can cause acute nausea, vomiting, and nasopharyngitis, followed within days by fever, malaise, dyspnea, and inflammatory pneumonitis.
Clitocybe acromelalga, Clitocybe amoenolens
Onset 6–24 hours: symptoms of numbness, burning pain, paresthesias, reddish edema in fingers and toes.
Tricholoma equestre, Russula subnigricans
Onset 24–72 hours: fatigue, muscle weakness, rhabdomyolysis, renal insufficiency, and myocarditis.
Delayed CNS toxicity
Onset after 24 hours: decreased visual acuity, somnolence, reduced motor tone and activity, electrolyte disturbances, and hepatorenal failure.