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Mushroom Poisoning

Mushroom Poisonings


Presentation

  • Of these, 60 (90%) cases presented with gastrointestinal symptoms of vomiting, diarrhoea, and abdominal pain.[ncbi.nlm.nih.gov]
  • The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome.[ncbi.nlm.nih.gov]
  • When presenting to the ED, the most frequent complaint was nausea-vomiting.[ncbi.nlm.nih.gov]
  • Thirty-eight patients (44%) were involved in cluster presentations. Mushroom poisoning is an unusual but potentially severe form of intoxication.[ncbi.nlm.nih.gov]
  • We present an outbreak of Russula subnigricans poisoning with rhabdomyolysis.[ncbi.nlm.nih.gov]
Fatigue
  • The first symptoms seen were loss of consciousness, fatigue, dizziness, severe headaches, abdominal discomfort and vomiting. The symptoms characteristically appeared suddenly.[ncbi.nlm.nih.gov]
  • The symptoms of poisoning vary, depending on the species, from fatigue, hallucinating, stiff muscular spasms, which eventually lead to liver or kidney failure. “Your organs completely collapse once the poison has kicked into your body,” he said.[iol.co.za]
  • Symptoms include nausea, vomiting, abdominal pain, diarrhea, dizziness, headache, muscle cramps, bloating and fatigue. Signs of liver damage include right-sided abdominal pain, hepatitis and jaundice — yellow skin — within 48 hours.[mlive.com]
  • Gyromitra spp gyromitrin-mediated symptoms CNS symptoms: headache, ataxia, fatigue, nystagmus, tremor, bertigo, seizures (rare) 2-3 days: delayed hepatotoxicity (rare) 1-3 days after hepatotoxicity: hemolysis and methemoglobinaemia Immunohaemolytic, e.g[lifeinthefastlane.com]
Vomiting
  • Both began vomiting in 10 minutes. Vomiting in one continued for about 2 hours. Case 2: Idaho, male, 7, ate unknown amount of mushroom from grass in yard. Two hours later began vomiting (2x). Field identification was A garicus xanthodermus.[web.archive.org]
  • Second stage is a period of about 24 hours characterized by violent vomiting, bloody diarrhea, and severe abdominal cramps.[web.archive.org]
  • By the evening approximately six hours later all started feeling nausea, abdominal cramps and vomiting they rushed to nearest primary health care center.[ncbi.nlm.nih.gov]
  • Vomiting was rare. Seizures or myoclonic twitching occurred in 4/9 patients, but was controlled with standard anticonvulsant therapy. No other anticholinergic or cholinergic signs were prominent. Recovery was rapid and complete in all patients.[ncbi.nlm.nih.gov]
  • Two days after eating the mushrooms, all four men developed abdominal pain, nausea, diarrhea, and intractable vomiting.[ncbi.nlm.nih.gov]
Diarrhea
  • Eleven hours after the second ingestion, he awoke with headache and malaise, followed in another hour by violent explosive diarrhea. Intermittent diarrhea and occasional cramps persisted this time for 60 hours.[web.archive.org]
  • Although the diarrhea resolved after 24 hours, his PT and AST and bilirubin levels continued to rise.[cdc.gov]
  • The boy got deteriorated with diarrhea in addition to the previous gastrointestinal complains and died on third day.[ncbi.nlm.nih.gov]
  • Two days after eating the mushrooms, all four men developed abdominal pain, nausea, diarrhea, and intractable vomiting.[ncbi.nlm.nih.gov]
  • The typical symptoms of nausea, vomiting, abdominal pain, and diarrhea are nonspecific and can be mistaken for gastroenteritis. If not adequately treated, hepatic and renal failure may ensue within several days of ingestion.[ncbi.nlm.nih.gov]
Nausea
  • By the evening approximately six hours later all started feeling nausea, abdominal cramps and vomiting they rushed to nearest primary health care center.[ncbi.nlm.nih.gov]
  • Two days after eating the mushrooms, all four men developed abdominal pain, nausea, diarrhea, and intractable vomiting.[ncbi.nlm.nih.gov]
  • The typical symptoms of nausea, vomiting, abdominal pain, and diarrhea are nonspecific and can be mistaken for gastroenteritis. If not adequately treated, hepatic and renal failure may ensue within several days of ingestion.[ncbi.nlm.nih.gov]
  • All patients experienced nausea and vomiting associated with abdominal cramping, and three reported diarrhea. Four of the seven complained of weakness and dizziness. Two were diaphoretic on physical examination.[ncbi.nlm.nih.gov]
  • The outbreak began in Kermanshah province with increasing number of patients presenting with severe abdominal pain, nausea, vomiting, and diarrhea soon after consumption of wild mushrooms.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Two days after eating the mushrooms, all four men developed abdominal pain, nausea, diarrhea, and intractable vomiting.[ncbi.nlm.nih.gov]
  • The typical symptoms of nausea, vomiting, abdominal pain, and diarrhea are nonspecific and can be mistaken for gastroenteritis. If not adequately treated, hepatic and renal failure may ensue within several days of ingestion.[ncbi.nlm.nih.gov]
  • The outbreak began in Kermanshah province with increasing number of patients presenting with severe abdominal pain, nausea, vomiting, and diarrhea soon after consumption of wild mushrooms.[ncbi.nlm.nih.gov]
  • A 57-year-old male patient was admitted to the emergency room with nausea, vomiting, diarrhea, and abdominal pain. He reported ingesting wild mushrooms with his mother and sister about 2 days ago.[ncbi.nlm.nih.gov]
  • The commonest symptoms at the time of presentation in both adults and children was gastrointestinal (diarrhea, vomiting and abdominal pain). There were 12 mortalities and they died at the median interval of 3.5 days after admission.[ncbi.nlm.nih.gov]
Abdominal Cramps
  • By the evening approximately six hours later all started feeling nausea, abdominal cramps and vomiting they rushed to nearest primary health care center.[ncbi.nlm.nih.gov]
  • All patients experienced nausea and vomiting associated with abdominal cramping, and three reported diarrhea. Four of the seven complained of weakness and dizziness. Two were diaphoretic on physical examination.[ncbi.nlm.nih.gov]
  • Reported symptoms were nausea 27 (100%), vomiting 24 (88.88%), abdominal cramping 8 (29.6%), jaundice 3 (11.1%), diarrhea 17 (62.96%) and altered sensorium in 8 patients (29.65%). All patients were treated conservatively.[ncbi.nlm.nih.gov]
  • The toxins initially cause severe abdominal cramping, vomiting, and watery diarrhea, and then lead to liver and kidney failure.[encyclopedia.com]
Jaundice
  • Jaundice was observed in 44% of cases, with a 50% rate of hepatic encephalopathy. A total of 66% of patients were discharged and the duration range of hospitalization was 1-12 days.[ncbi.nlm.nih.gov]
  • Reported symptoms were nausea 27 (100%), vomiting 24 (88.88%), abdominal cramping 8 (29.6%), jaundice 3 (11.1%), diarrhea 17 (62.96%) and altered sensorium in 8 patients (29.65%). All patients were treated conservatively.[ncbi.nlm.nih.gov]
  • The chemical nature of the toxin has not been determined, but it is a source of monomethylhydrazine, which affects the central nervous system and induces hemolytic jaundice. Facts Matter. Support the truth and unlock all of Britannica’s content.[britannica.com]
  • The chemical nature of the toxin has not been determined, but it is a source of monomethylhydrazine, which affects the central nervous system and induces hemolytic jaundice .[britannica.com]
  • Signs of liver damage include right-sided abdominal pain, hepatitis and jaundice — yellow skin — within 48 hours. True morels (Morchella species) can make people sick, too, if undercooked or eaten raw, or if they are eaten with alcoholic beverages.[mlive.com]
Hypotension
  • The clinical manifestations included combinations of nausea, vomiting, diarrhea, abdominal pain, hypersalivation, diaphoresis, tachycardia, bradycardia, hypotension, lacrimation, blurred vision, miosis, tremor, restlessness, flushing, and syncope.[ncbi.nlm.nih.gov]
  • He was found diaphoretic, hypotensive, bradycardic, and slightly confused at presentation. No signs of trauma were observed on physical examination. The patient had weakness of the right limbs and bilateral severe myosis.[ncbi.nlm.nih.gov]
  • He was admitted to a hospital 17 hours after ingestion because of orthostatic hypotension and dehydration.[cdc.gov]
  • Denver, CO 80204-4507 Abstract Mushroom poisoning can cause a wide range of symptoms including gastroenteritis, euphoria or hallucinations, cholinergic or anticholinergic syndromes, disulfiram-like reactions (flushing, anxiety, palpitations, possible hypotension[pedsinreview.aappublications.org]
  • Symptoms generally begin 6-24 hours after ingestion and may include the explosive onset of violent abdominal pain, vomiting, diarrhea, hematuria, fever, tachycardia, hypotension, rapid volume depletion, fluid and electrolyte imbalance, and extreme thirst[cdc.gov]
Tachycardia
  • The most common ECG abnormalities in the patients with MP were sinus tachycardia, sinus arrhythmia, ST/T inversion, 1st degree AV block and QT prolongation, respectively. Cardiac markers of the patients were found to be normal.[ncbi.nlm.nih.gov]
  • The most severely ill patient presented with rhabdomyolysis, severe electrolyte disturbance (hyperkalemia, hypocalcemia), respiratory failure, acute renal failure, pulmonary edema, ventricular tachycardia, and circulatory shock.[ncbi.nlm.nih.gov]
  • This report represents the first record of R. subnigricans poisoning with rhabdomyolysis in Korea, describing a 51-year-old man who suffered from rhabdomyolysis, acute kidney injury, severe hypocalcemia, respiratory failure, ventricular tachycardia, cardiogenic[ncbi.nlm.nih.gov]
  • The clinical manifestations included combinations of nausea, vomiting, diarrhea, abdominal pain, hypersalivation, diaphoresis, tachycardia, bradycardia, hypotension, lacrimation, blurred vision, miosis, tremor, restlessness, flushing, and syncope.[ncbi.nlm.nih.gov]
  • Symptoms generally begin 6-24 hours after ingestion and may include the explosive onset of violent abdominal pain, vomiting, diarrhea, hematuria, fever, tachycardia, hypotension, rapid volume depletion, fluid and electrolyte imbalance, and extreme thirst[cdc.gov]
Slow Pulse
  • The symptoms for this poisoning are: profuse, prolonged sweating tearing drooling small pupils vomiting and diarrhea slow pulse and low blood pressure in severe cases Victims usually recover within 24 hours but death may occur.[kidemergencies.com]
Orthostatic Hypotension
  • He was admitted to a hospital 17 hours after ingestion because of orthostatic hypotension and dehydration.[cdc.gov]
Orthostatic Hypotension
  • He was admitted to a hospital 17 hours after ingestion because of orthostatic hypotension and dehydration.[cdc.gov]
Headache
  • The first symptoms seen were loss of consciousness, fatigue, dizziness, severe headaches, abdominal discomfort and vomiting. The symptoms characteristically appeared suddenly.[ncbi.nlm.nih.gov]
  • Symptoms include: nasea vomiting lethargy headache frequent urination burning thirst progression to kidney failure (dialysis required) Group 9 Amanita smithiana is the mushroom in this group Mushrooms are similar in appearance to edible mutsutake (see[kidemergencies.com]
  • Symptoms appear within 2 to 24 hours and include headaches, abdominal distress, severe diarrhea, and vomiting. In severe cases, liver, kidney, and red blood cell damage may occur, possibly resulting in death.[web.archive.org]
  • He suffered diarrhea, dizziness, severe headache, intestinal cramps, nausea, sweating and vomiting. Blood work showed kidney/liver damage and compromise.[web.archive.org]
  • Other symptoms : • Diarrhea, • Fever, • Headache, • Weakness, • Drowsiness, • Dizziness, sweating, • Confusion, and hallucination. 13.[slideshare.net]
Dizziness
  • Four of the seven complained of weakness and dizziness. Two were diaphoretic on physical examination. All seven were given IV fluids and oral activated charcoal in a local emergency department and admitted overnight for observation.[ncbi.nlm.nih.gov]
  • The first symptoms seen were loss of consciousness, fatigue, dizziness, severe headaches, abdominal discomfort and vomiting. The symptoms characteristically appeared suddenly.[ncbi.nlm.nih.gov]
  • Male also consumed a glass of wine and about 1 hour later felt drunk, dizzy, bloated, and nauseated. One female was dizzy and nauseated. Second female was nauseated and vomited (2x).[web.archive.org]
  • Other symptoms : • Diarrhea, • Fever, • Headache, • Weakness, • Drowsiness, • Dizziness, sweating, • Confusion, and hallucination. 13.[slideshare.net]
  • The clinical presentation of our four cases included dizziness, headache, generalised weakness and numbness. Three out of four patients presented with visual hallucination.[hkmj.org]
Vertigo
  • […] vision, vomiting, and a coma-like state Delayed-onset symptoms GI/headache/liver damage Toxin monomethylhydrazine–MMH; symptoms begin within 6-12 hrs of ingestion, and include bloating, nausea, vomiting, diarrhea, abdominal pain, muscle cramps, and vertigo[medical-dictionary.thefreedictionary.com]
  • This phase may be followed by monomethylhydrazine-related CNS symptoms such as vertigo, delirium, convulsions, and coma.[emedicine.medscape.com]
Kidney Failure
  • Beyond the standard management of kidney failure, there is little but supportive treatment of use in cases of orellanine poisoning.[web.archive.org]
  • The toxins initially cause severe abdominal cramping, vomiting, and watery diarrhea, and then lead to liver and kidney failure.[encyclopedia.com]
  • Some mushrooms can cause liver/kidney failure and death. Symptoms may occur within 30 minutes to 24 hours after ingestion depending on type and amount of poisonous mushroom consumed; and the general health of the individual.[health.nsw.gov.au]
Hematuria
  • Upon examining laboratory results, 17.9% revealed variations in hematological parameters, impairment in renal functions in 6 patients (7.6%), hematuria in 10 patients (12.8%) and 15.3% had primarily elevated liver enzymes.[ncbi.nlm.nih.gov]
  • Symptoms generally begin 6-24 hours after ingestion and may include the explosive onset of violent abdominal pain, vomiting, diarrhea, hematuria, fever, tachycardia, hypotension, rapid volume depletion, fluid and electrolyte imbalance, and extreme thirst[cdc.gov]

Workup

  • The workup may include laboratory studies, diagnostic imaging (though specific studies are not indicated if there is already a clear history of mushroom ingestion), and analysis of mushroom specimens if available (see Workup).[emedicine.com]
  • Identification of the mushroom by a mycologist is desirable (see Workup). Care is primarily supportive. Symptoms usually subside in 6-8 hours, though some may take as long as several days to resolve fully.[emedicine.com]
  • The entire mushroom that he had was consumed and nothing was available to confirm the identification, but the symptoms and blood workup was consistent with Amanita phalloides.[web.archive.org]

Treatment

  • No serious adverse side-effects were observed with the MARS treatment. In conclusion, MARS treatment seems to offer a safe and effective treatment option in Amanita mushroom poisoning.[ncbi.nlm.nih.gov]
  • Intensive treatment was begun before the results of urine amatoxin assay were reported.[ncbi.nlm.nih.gov]
  • Therefore, it may be a promising treatment option for patients with liver failure due to mushroom poisoning. METHODOLOGY: We studied 8 patients with mushroom poisoning.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To assess the effects of treatment of Amanita mushroom poisoning with Glossy anoderma Decoction (, GGD).[ncbi.nlm.nih.gov]
  • The evolution of hepatotoxicity led us to offer investigational treatment with silibinin, an extract of Mediterranean milk thistle.[ncbi.nlm.nih.gov]

Prognosis

  • A short time interval between the ingestion of poisonous fungi and the onset of symptoms, in our cases within one hour, indicates a good prognosis.[ncbi.nlm.nih.gov]
  • Early determination of prognosis in cases of FHF is important to allow prompt decision-making regarding the need for liver transplantation. Mushroom poisoning is a rare cause of FHF, and as a result, prognostic criteria are not well recognized.[ncbi.nlm.nih.gov]
  • Early hemodialysis can improve the prognosis of this potentially life-threatening condition.[ncbi.nlm.nih.gov]
  • The syndrome induced by Amanita smithiana/proxima consists of acute tubulopathy, which appears earlier and does not have the same poor prognosis as the orellanine-induced syndrome.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Patients with severe hepatitis from mushroom poisoning are thought to have a poor prognosis and frequently need liver transplantation for survival.[ncbi.nlm.nih.gov]

Etiology

  • There are numerous causes of fulminant hepatic failure including acetaminophen, viral etiologies, acute fatty liver of pregnancy, ischemic hepatitis, and acute Budd-Chiari syndrome.[ncbi.nlm.nih.gov]
  • Fulminant hepatic failure in children: Etiology, histopathology and MDCT findings. Eur. J. Radiol., 72: 327-334. CrossRef PubMed Direct Link Chodorowski, Z., W. Waldman and J.S. Anand, 2002. Acute poisoning with Tricholoma equestre . Przegl.[scialert.net]
  • Etiology MMH poisoning may occur after ingestion of fresh, dried, or raw gyromitrin-containing mushrooms or with inhalation of vapors while cooking gyromitrin-containing mushrooms. Severity depends on amount of toxin ingested.[emedicine.com]
  • Etiology Amatoxin toxicity is caused by the ingestion of mushrooms containing the toxin (especially Amanita phalloides ), such as may occur in any of the following circumstances: Amateur mushroom hunters seeking a fresh-picked meal Adults and adolescents[emedicine.com]
  • They are structural analogues of serotonin (5-hydroxytryptamine [5-HT]); thus, hallucinogenic effects probably are mediated through effects on serotonergic receptors. [2] Etiology Hallucinogenic mushroom toxicity is caused by ingestion of fungi containing[emedicine.com]

Epidemiology

  • BACKGROUND: Limited information exists about epidemiology and management of mushroom poisoning.[ncbi.nlm.nih.gov]
  • Abstract An analysis of mushroom case exposures reported in 1989 to the American Association of Poison Control Centers "National Data Collection System" by poison centers in the United States was conducted to obtain a clearer view of mushroom poisoning epidemiology[ncbi.nlm.nih.gov]
  • Epidemiological information, clinical data, and results of laboratory examinations were collected and analyzed. The mushroom samples were all identified as A. exitialis.[ncbi.nlm.nih.gov]
  • The aim of this study was to describe the epidemiology of mushroom poisoning in Ireland, to describe the working arrangement between the National Poisons Information Centre (NPIC) and professional mycologists and to present a case series detailing the[ncbi.nlm.nih.gov]
  • Community Hospital, Santa Rosa; J Young, PHN, R Holtzer, MD, Sonoma County Health Dept, TG Tong, PharmD, San Francisco Poison Control Center, RR Roberto, MD, SB Werner, MD, Infectious Disease Section, California Dept of Health Svcs; Enteric Bacteriology and Epidemiology[cdc.gov]
Sex distribution
Age distribution

Pathophysiology

  • Most fatalities resulting from mushroom ingestion are associated with amatoxins within the mushrooms (see Pathophysiology).[emedicine.com]
  • Pathophysiology Some Gyromitra mushrooms contain hydrazones, including the toxin gyromitrin ( N -methyl-N-formylhydrazone).[emedicine.com]
  • Pathophysiology Coprinus atramentarius contains coprine (N5-1-hydroxycyclopropyl-L-glutamine), a protoxin without intrinsic toxicity. Coprine is metabolized to 1-aminocyclopropanol, which inhibits the enzyme aldehyde dehydrogenase (ALDH).[emedicine.com]
  • Reports of toxicity associated with this group of mushrooms have increased as a consequence of their growing popularity as hallucinogens. [4] Pathophysiology A muscaria, A pantherina, and A gemmata contain ibotenic acid, muscimol, and muscazone.[emedicine.com]
  • Metabolic acidosis: pathophysiology, diagnosis and management. J Nephrol. 2006; 19 (Suppl 9):S62–S69. [ PubMed ] 20. Liamis G, Milionis HJ, Elisaf M. Pharmacologically-induced metabolic acidosis: a review.[ncbi.nlm.nih.gov]

Prevention

  • To prevent similar outbreaks, raising public awareness about risky behaviors of collecting and consuming wild self-picked mushrooms is of paramount importance. Herein, we present our experience with this outbreak.[ncbi.nlm.nih.gov]
  • In order to prevent mushroom poisoning altogether, educating the general population to that end certainly presents the method of choice.[ncbi.nlm.nih.gov]
  • Diagnosis is essentially clinical and no specific therapy has been shown to be effective in preventing and treating renal damage.[ncbi.nlm.nih.gov]
  • Public awareness is very important in prevention of intoxication as well as encouraging early admission to hospitals.[ncbi.nlm.nih.gov]
  • Community based awareness programs will help prevent the instances of poisoning.[ncbi.nlm.nih.gov]

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