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.
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 |Favorite Table|Download (.pdf)
Table 128-1 Mushrooms: Symptoms, Toxicity, and Treatment
| Onset <2 h|
Nausea, vomiting, diarrhea (occasional bloody)
Onset 6 to 24 h
(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
|Salivation, lacrimation, diarrhea, gastrointestinal distress, emesis||Supportive, atropine 0.01 milligrams/kilogram IV repeated as needed for severe secretions|
|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|
|Visual hallucinations, ataxia||Supportive, sedation with or diazepam 2 to 5 milligrams IV for adults|
- Onset 2 to 72 h after mushroom, and <30 min after alcohol
|Headache, flushing, tachycardia, hyperventilation, palpitations||Supportive IV hydration|
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 ingestion. Toxic species include Amanita, Galerina, Gyromitra, and Lepiota. Ingestions may be misdiagnosed as ...