Mushroom Poisoning

Introduction

Mushroom poisoning can cause a wide range of syndromes which differ in time course and clinical effects, including gastrointestinal toxicity, neurotoxicity or hallucinogenic properties.

The severity of the poisoning is dependent on the quantity ingested as well as whether the mushroom was cooked.

If possible it is best to obtain and identify the specimen with the help of a mycologist.

Gastrointestinal mushroom poisoning occurs most commonly with recreational foragers consuming wild mushrooms1. Hallucinogenic mushroom poisoning is also more readily seen, particularly with increasing availability on the internet.1

Below is a brief overview of different mushroom toxidromes, it is useful group them into early and late onet of toxicity.

Early Onset of Toxicity < 6 hours

 

Late Onset of Toxicity 6 hours to days

Management

The treatment of toxicity following most mushroom ingestion is largely supportive.

If there are prominent cholinergic symptoms, ie following Clitocybe or Inocybe ingestion, atropine is helpful until the peripheral muscarinic effects subside.

Treat any seizures with benzodiazepines.

Amatoxic hepatotoxicity requires special mention however.

Amatoxin Mushroom ingestion

Toxicokinetics

Amatoxins inhibits RNA polymerase II, blocking transcription and leading to cell death. As little as 50g of ingestion has been reported to be fatal. Amatoxins are renally excreted over 48h. There is high uptake in the liver and kidneys.

Decontamination

MDAC may improve outcome and should be provided.

Antidote

Although not specific antidotes, multiple therapies have been used to little demonstrated efficacy.

Standard course of NAC should be commenced on all patients with suspected amatoxin ingestion.

 

The following are often considered in consultantion with the toxicology unit1;

  • Silymarine (milk thistle) 5mg/kg IV qid for 3 days

or

  • Benzyl penicillin 300mg/kg/d for 3d in 4 divided doses

or

  • Rifampicin 10-20mg/kg IV daily (max 600mg/d)

Supportive Measures

  • Fluid resuscitation
  • Liver transplantation may be necessary

Further reading

References

  1. Diaz J. ‘Syndromic diagnosis and management of confirmed mushroom poisonings.’ Crit Care Med 2005; 33:427-436
  2. http://wikitoxin.toxicology.wikispaces.net/Mushrooms
  3. Barbato MP. “Poisoning from accidental ingestion of mushrooms.” MJA 1993; 158: 843-7