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Chapter 128: Mushroom and Plant Poisoning

Chulathida Chomchai

MUSHROOMS

Mushroom poisoning occurs in four population groups: foragers who purposefully harvest mushrooms or plants for food; teenagers and young adults who use mushrooms to get “high”; preschool-age children who accidentally ingest mushrooms while playing outdoors; and, rarely, victims of attempted homicide or suicide.

Clinical Features

Mushroom toxicity is divided into those with early onset, defined as within 2 hours after ingestion, and delayed onset, defined as 6 hours to 20 days after ingestion. It is important to determine if patients ingested only one type or multiple types of mushrooms and the time elapsed from ingestion to symptoms. Foragers may be able to provide a description of the mushroom. Clinical features of common mushroom poisonings are listed in Table 128-1.

Table 128-1

Mushrooms: Symptoms, Toxicity, and Treatment

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Table 128-1

Mushrooms: Symptoms, Toxicity, and Treatment
Symptoms Mushrooms Toxicity Treatment
Gastrointestinal symptoms
    Onset <2 h

  • Chlorophyllum molybdites

  • Omphalotus illudens

  • Cantharellus cibarius

  • Nausea, vomiting, diarrhea (occasional bloody)

  • IV hydration

  • Antiemetics
    Onset 6–24 h

  • Amanita smithiana

  • (delayed renal failure)

  • Amanita phalloides, Amanita verna, Amanita virosa

  • Lepiota sp.

  • (delayed liver failure)

  • Gyromitra esculenta

  • (delayed onset seizures)

  • Initial: nausea, vomiting, diarrhea

  • Day 2: rise in AST, ALT

  • Day 3: hepatic failure coagulopathy

  •     renal failure

  •     hemolysis

  • As above + headache, tremor, ataxia, seizures

  • IV hydration; closely monitor electrolytes, glucose, renal, hepatic, and coagulation functions

  • For Amanita and Lepiota:

  • Acetylcysteine, load with 140  mg/kg PO/NG

  • Penicillin G 300,000 to 1,000,000  U/kg IV per day

  • Silymarin 5 mg/kg IV over 1 h, then 20  mg/kg

  • IV per day (available PO in the United States)

  • For Gyromitra, treat seizures with both benzodiazepines AND pyridoxine 5 g IV
Muscarinic (SLUDGE) syndrome Inocybe sp. Salivation, lacrimation, diarrhea, gastrointestinal distress, emesis Supportive, atropine 0.01 mg/kg IV repeated as needed for severe secretions
   Onset <30 min Clitocybe sp.
CNS excitement Amanita muscaria Intoxication, dizziness, ataxia, visual disturbances, seizures, tachycardia, hypertension, warm dry skin, dry mouth, mydriasis (anticholinergic effects) Supportive, sedation with diazepam 2–5 mg IV as needed for adults
  Onset <30 min Amanita pantherina
Amanita gemmata
Hallucinations Paneolus Visual hallucinations, ataxia Supportive, sedation with or diazepam 2–5 mg IV for adults
  Onset <30 min Psilocybe sp.
Gymnopillus spectabilis
Disulfiram Coprinus atramentarius Headache, flushing, tachycardia, hyperventilation, palpitations Supportive IV hydration
   Onset 2–72 h after mushroom, and <30 min after alcohol Clitocybe clavipes

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CNS, central nervous system; IV, intravenous; PT, prothrombin time; PTT, partial thromboplastin time; SLUDGE syndrome, salivation, lacrimation, urination, defecation, gastrointestinal hypermotility, and emesis.

Diagnosis and Differential

Most patients who develop GI symptoms within 2 hours of ingestion have a reassuring clinical course and do not develop major organ failure (Table 128-1). An exception to this is Amanita smithiana ingestion, which results in early GI symptoms and delayed renal failure. Mushrooms with potential liver, kidney, and CNS effects are often associated with onset of vomiting that is ...

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