0071643192.pdf

ENVIRONMENTAL EMERGENCIES

GI EFFECTSFOLLOWED BYRENALFAILURE

■ Cortinarius orellanus

■ Caused by orellanine toxin, a nephrotoxin

■ Sx/Exam: Delayed nausea/vomiting and diarrhea followed by renal failure

TREATMENT

■ Observe for development of early onset symptoms (4–6 hours).

■ If no early onset symptoms, have patient return if delayed symptoms

develop.

■ Mainstay of therapy is supportive care.

■ Monitor glucose(hypoglycemia is common).

■ Atropine if symptomatic bradycardia or bronchorrhea from muscarinic

syndrome

■ Benzodiazepines to control agitation

■ Pyridoxine: For delayed onset seizures (inhibition of pyridoxine-dependent

pathways)