0071643192.pdf

ENVIRONMENTAL EMERGENCIES

Delayed Onset Toxicity

Delayed onset toxicity is a marker for ingestion of mushrooms with potential
for serious toxicity. In these cases GI symptoms (nausea/vomiting, diarrhea)
do not begin until 6–24 hours after ingestion and are followed by liver, CNS,
or renal toxicity:

GI EFFECTSFOLLOWED BYHEPATOTOXICITY

■ Seen with Amanita phalloides
■ Caused by amatoxins and phallotoxins
■ Sx/Exam: Delayed nausea/vomiting and diarrhea followed by hepatic failure
in 72 hours

GI EFFECTSFOLLOWED BYSEIZURES

■ Seen with Gyromitrasp.
■ Caused by gyromitrin toxin which inhibits pyridoxine-dependent pathways
and depletes GABA (similar to INH overdose)
■ Sx/Exam: Delayed nausea/vomiting and diarrhea followed by seizures

TABLE 13.16. Mushroom Toxicity

CLINICALSYMPTOMS REPRESENTATIVEMUSHROOM TOXIN TREATMENT

Early Onset (0–4 hours)

Gastrointestinal Many species Supportive and symptomatic

Muscarinic (SLUDGE) Cytocybesp. Muscarine Atropine for bradycardia and bronchorrhea

Inocybesp.

CNS excitation Amanita mucarinia Muscimol, ibotenic acid Supportive and symptomatic

Hallucinations Psilocybesp. Psilocybin Supportive

Benzodiazepines

Disulfarim-like reaction Coprinussp. Coprine (with ETOH) Supportive

Benzodiazepines

Delayed Onset (6–24 hours)

Gastroenteritis followed by Amanita phalloides Amatoxins, phallotoxins Supportive and symptomtic

hepatotoxicity Gyrometrasp. Gyromitrin May require transplant

Supportive

Gastroenteritis followed Benzodiazepines

by seizures Pyridoxine

Gastroenteritis followed by Cortinarius orellanus Orellanine Supportive

renal failure May require hemodialysis

Mushroom toxicity:

Early onset GI symptoms →

benign course.

Delayed onset GI symptoms

→potential for serious

toxicity.