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Home Books Tintinalli's Emergency Medicine Manual, 7e

Chapter 128. Mushroom and Plant Poisoning

B. Zane Horowitz

Mushroom poisoning occurs in 4 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

Determine if patients ingested only 1 type or multiple types of mushrooms and 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
SymptomsMushroomsToxicityTreatment
Gastrointestinal symptoms
 Onset <2 h

Chlorophyllum molybdites

Omphalotus illudens

Cantharellus cibarius

Nausea, vomiting, diarrhea (occasional bloody)

IV hydration

Antiemetics

 Onset 6 to 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 function

For Amanita and Lepiota

 Acetylcysteine, load with 140 milligrams/kilogram po/NG

 Penicillin G 300,000 to 1 000 000 units/kilogram IV per day

 Silymarin 5 milligrams/kilogram IV over 1 h, then 20 milligrams/kilogram IV per day (available PO in the United States)

 For Gyromitra, treat seizures with both benzodiazepines AND pyridoxine 5 grams IV.

Muscarinic (SLUDGE) syndrome

  • Onset <30 min

Inocybe sp.

Clitocybe sp.

Salivation, lacrimation, diarrhea, gastrointestinal distress, emesisSupportive, atropine 0.01 milligrams/kilogram IV repeated as needed for severe secretions

CNS excitement

  • Onset < 30 min

Amanita muscaria

Amanita pantherina

Amanita gemmata

Intoxication, dizziness, ataxia, visual disturbances, seizures, tachycardia, hypertension, warm dry skin, dry mouth, mydriasis (anticholinergic effects)Supportive, sedation with diazepam 2 to 5 milligrams IV as needed for adults

Hallucinations

  • Onset < 30 min

Paneolus

Psilocybe sp.

Gymnopillus spectabilis

Visual hallucinations, ataxiaSupportive, sedation with or diazepam 2 to 5 milligrams IV for adults

Disulfiram

  • Onset 2 to 72 h after mushroom, and <30 min after alcohol

Coprinus atramentarius

Clitocybe clavipes

Headache, flushing, tachycardia, hyperventilation, palpitationsSupportive IV hydration

Key: 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 that 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 delayed for 6 or more hours after ...

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