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Clinical Summary

While many species of mushrooms can cause toxicity when ingested, only a few contain amatoxins and account for most fatalities attributed to mushroom ingestion. Examples include Amanita phalloides (the “death cap”) and Amanita ocreata (the “destroying angel”) species. Amatoxin poisoning results in severe symptoms of gastroenteritis at least 6 to 24 hours after ingestion. Symptoms include nausea, vomiting, profuse watery diarrhea, and abdominal pain. GI symptoms may last 12 to 24 hours and are followed by a latent period of apparent improvement. This period is followed by a rise in liver enzymes and bilirubin. Fulminant hepatic failure and renal failure may become apparent.

The more common mushroom exposures include those with GI toxins. Ingestions result in acute nausea, vomiting, and diarrhea that occur within 2 hours of ingestion (eg, < 6 hours of ingestion). An example of this type of mushroom is the Chlorophyllum molybdites, which looks like a toasted marshmallow in the grass. Other types of mushroom poisonings include gyromitrin-containing mushrooms that are misidentified for the popular morels. Gyromitrin mushrooms cause status epilepticus that is responsive to high-dose pyridoxine. Coprine-containing mushrooms only cause toxicity when ethanol is co-ingested as they cause a disulfiram reaction.

FIGURE 17.91

Amanita phalloides. The “death cap” produces amatoxins and accounts for most of the fatalities due to mushroom ingestion. (Photo contributor: Edward J. Otten, MD.)

Management and Disposition

For the GI toxin–containing mushrooms, management is supportive care. For the amatoxin-containing mushroom, administration of activated charcoal may be recommended depending on the time since ingestion. Specific interventions that may be helpful but are yet unproved include charcoal hemoperfusion, high-dose cimetidine, high-dose penicillin, high-dose ascorbic acid, silibinin, and N-acetylcysteine. Consultation with the local poison center is recommended.

FIGURE 17.92

Amanita ocreata. These mushrooms were samples of Amanita ocreata provided by a family who had ingested them and subsequently developed significant hepatotoxicity. (Photo contributor: Division of Medical Toxicology, University of California, San Diego.)

FIGURE 17.93

Morel Mushroom. Morels are considered a delicacy; however, inexperienced mushroom hunters may collect a “false morel,” which contains gyromitrin. Ingestion of gyromitrin results in status epilepticus that is responsive to intravenous pyridoxine. (Photo contributor: Saralyn R. Williams, MD.)

Pearls

  1. A single “death cap” may contain enough amatoxin to kill an adult.

  2. Cooking mushrooms does not substantially alter their toxicity.

  3. Not all Amanita species of mushrooms cause hepatotoxicity when ingested. Some Amanita species are hallucinogens, and one causes renal failure.

  4. Be wary of using the “6-hour rule” with mushroom scavengers who may have ingested multiple species of mushrooms.

FIGURE 17.94

Chlorophyllum molybdites. This mushroom is ubiquitous and ...

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