Download mushrooms - Hatzalah of Miami-Dade

MUSHROOMS
Cyclopeptide Containing
Mushrooms
http://www.inf.unitn.it./~mflorian/
mycology/fungi/amanphal.html
• 95% of mushroom fatalities are due to
these
• Include A. verna (death angel), A. virosa
(destroying angel), A. phalloides (death
cap)
• Also, Galerina autumnalis, G. marginata,
G. Venenata, and Lepiota helveola
Symptoms
• Usually not before 6-12 hours
• Include profuse, watery diarrhea, and
gastroenteritis at 12-24 hours; transient
improvement
• 1-6 days later; hepatic, renal and at
times pancreatic toxicity and death
• Toxin is heat-stable, insoluble in water
and loses activity very slowly over years
• Mortality related to age and dose
(0.1 mg/kg is lethal)
• Children are more susceptible
• Toxicity of alpha-aminitin is through
interference with RNA polymerase II,
prevents the transcription of DNA
• Phalotoxins are rapid-acting and
interrupt actin polymerization, impair
cell membrane function, has limited
absorption.
Therapy
• Continuous gastrointestinal charcoal
lavage to decontaminate (theoretically,
up to five days)
• Watch for altered mental status due
to hypoglycemia
• Supportive therapy
Antidotes
• Penicillin displaces amatoxin from
plasma protein-binding sites
• May inhibit penetration of amatoxin
into hepatocytes
• Doses of 300,000 to 1,000,000 units
benzyl penicillin daily
• N-acetylcysteine may be helpful as
in any patient with liver injury
Other Antidotes
• Thioctic acid (alpha-lipoic acid)
• Silibinin (extract of silymarin from
Silybum marianum)
• Cimetidine may be hepatoprotective.
• Consider liver transplantation early
(Prior to grade III hepatic encephalopathy)
Monomethylhydrazine Containing Mushrooms
http://www.wisc.edu/botany/fungi/apr97
• Associated with mortality of 40%
• Include G. californica, G. brunnea,
G. esculenta
• Toxicity is due to gyromitrin which is
metabolized to monomethylhydrazine
• This metabolite reacts with pyridoxine
resulting in inhibition of pyridoxal
phosphate-related enzymatic reactions
Symptoms
• Headache, nausea, vomiting, seizures,
and hepatorenal failure
• Symptoms occur 6-10 hours after
ingestion
• Toxin may be eliminated with cooking
but inhalation of cooking fumes may
cause poisoning
Therapy
• Pyridoxine, in dose of 25 mg/kg
Glutamate  Glutamic Acid  GABA
Pyridoxal 5'
phosphate
Muscarine-Containing
Mushrooms
http://www.inf.unitn.it./~mflorian/
mycology/fungi/clitphae
• No lethality
• Includes Clitocybe dealbata (the
sweater), C. Illudens (omphalotus
olearius) and Inocybe lacera
• Small amounts of muscarine are
in Amanitia muscaria
• Symptoms: SLUDGE within 0.5-2 hours
• Therapy: Atropine
Coprine-Containing Mushrooms
• Rarely fatal
• Coprinus atramentarius (inky caps)
• Coprine has a disulfiramlike effect
(Blocks acetaldehyde dehydrogenase)
• Requires ingestion of alcohol 48-72
hours after mushroom
• Symptoms: Flushing, headache,
hypotension, histamine induced
vasodilation
• Therapy: Supportive, anti H1 and
anti H2, prostaglandin inhibitors
Ibotenic Acid- and MuscimolContaining Mushrooms
http://www.inf.unitn.it./~mflorian/
mycology/fungi/amanpant
• Not lethal
• Amanita gemmata, A. muscaria and
A. pantherina
• Symptoms: Within 0.5-2 hours,
somnolence, hallucinations and
delirium, in adults
• Also, myoclonus, seizures and other
neurologic effects in children
• Action is due to stimulation
of GABA receptors
• Therapy: Benzodiazepine
Psilocybin-Containing
Mushrooms
http://www.halcyon.com/
mycomed/gallery1
• Rare mortality
• Symptoms: In 0.5-1 hour, CNS effects:
ataxia, hyperkinesis, hallucinations, and
seizures
• Psilocybe cubensis, P. caerulescens,
Conocybe cyanopus, Panaeolus
foenisecii, Gymnopilus spectabilis,
Psathyrella foenisecii
Gastrointestinal Toxins
http://www.inf.unitn.it./~mflorian/
mycology/fungi/bolevent
• Death is rare
• “Little brown mushrooms”
• Boletes, Lactarius, Rhodophyllus,
Tricholoma, Chlorophyllum
molybidites, C. esculentum
Symptoms
• Variable but usually in 0.5-3 hours
• Nausea, vomiting diarrhea and
epigastric distress
• Supportive therapy
• Resolution of symptoms in 6-24 hours
Orelline-and OrellanineContaining Mushrooms
http://www.inf.unitn.it./~mflorian/
mycology/fungi/corteleg
• May be lethal
• Symptoms: In 24-36 hours, headache,
chills, anorexia, nausea, gastritis
• Hepatotoxicity, and oliguric renal failure
may develop
• Therapy: Supportive
Ralph's Rules
• If uncertain of the identity
of a species, don't try it
Try to Identify New Species
• Draw no conclusions until definitive
spore print, cross section of gill, stem
and bruise color.
• Be able to state with confidence what
distinguishes specimen from 3-5 look
alikes
• Confidence of limits of variability
of species
• Photos confirm identity
• Odor, bruising, brittleness, habit,
...support identification
• Avoid LBM's, amanita, cortinarius
• Use recent texts and monographs
• Must be worth eating
• Eat slowly: first taste the species.
Second taste is more than 24 hours
later.
• Wait another 24 hours before trying
a full-sized serving
• Do not over-indulge
• Gather only one species at a time
• Do not eat more than one species
at a time
• Do not eat any species raw