0071643192.pdf

ENVIRONMENTAL EMERGENCIES

A 54-year-old male presents to the ED with nausea/vomiting and abdominal

pain. He reports eating some “unusual” mushrooms while out in the woods

earlier in the day, but felt fine until about 7 hours later when the GI symp-

toms started. What can you tell this patient about his likelihood of having a serious

mushroom poisoning?

Assuming his symptoms are due to ingestion of mushrooms, the onset of symp-

toms are > 6 hours since the time of ingestion, indicating a potential for serious toxi-

city. Depending on the species, hepatotoxicity, renal toxicity or seizures could de-

velop. Consultation with a local mycologist may help determine the likely species.

MUSHROOMS

Mushroom toxicity may occur during experimental ingestions by patients

looking for a “high” or in foragers who misidentify the species. The toxic dose

is unknown and the amount of toxin varies widely among mushrooms.

Mushroom toxicity can be divided into two groups based on the onset of

symptoms: Early onset toxicity and delayed onset toxicity.

Early Onset Toxicity

Symptom onset 0–4 hours after mushroom ingestion typically indicates a

benign course. The presentation varies with the type of mushroom ingested

(see Table 13.16).

GASTROINTESTINALSYMPTOMS

■ Seen with many mushroom species

■ Sx/Exam: Nausea/vomiting, diarrhea, abdominal pain

MUSCARINICSYMPTOMS

■ Seen with Clitocybesp., Inocybesp.

■ Sx/Exam: Symptoms of cholinergic (SLUDGE) syndrome: Excessivesecre-

tions, urination, ↑GI motility, bradycardia

CNS EXCITATION

■ Seen with Amanita muscaria

■ Sx/Exam: Intoxication, dizziness, and anticholinergic effects (dry mouth/

skin, mydriasis, tachycardia)

HALLUCINATIONS

■ Seen with Psilicybeand other psilocybin-containing mushrooms

■ Caused by toxin psilocybin, an LSD-like serotonin stimulator

■ Sx/Exam: Visual hallucinations

DISULFIRAM-LIKEREACTION(WITHCOINGESTION OFETOH)

■ Seen with Coprinussp.

■ Caused by toxin coprine, which inhibits ADH

■ Sx/Exam: Headache, flushing, tachycardia, hyperventilation

Amanita sp.causes most

deaths.