Gyromitra mushrooms: Difference between revisions
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==Background== | |||
[[File:Gyromitra_mushrooms.jpg|thumb|Gyromitra mushrooms]] | [[File:Gyromitra_mushrooms.jpg|thumb|Gyromitra mushrooms]] | ||
*Also known as "brain fungi" | *Also known as "brain fungi" | ||
*Fruit in the spring and early summer | *Fruit in the spring and early summer | ||
*Frequently mistaken for morel mushrooms<ref>Brozen R et al. Gyromitra Mushroom Toxicity. Apr 14, 2015. http://emedicine.medscape.com/article/817931-treatment#showall.</ref> | *Frequently mistaken for morel mushrooms<ref>Brozen R et al. Gyromitra Mushroom Toxicity. Apr 14, 2015. http://emedicine.medscape.com/article/817931-treatment#showall.</ref> | ||
*Inhibits formation of Vitamin B6 and GABA via hydrazine metabolite | *Inhibits formation of Vitamin B6 and GABA via hydrazine metabolite (similar to [[INH toxicity|isoniazid toxicity]]) | ||
==Clinical | ==Clinical Features== | ||
*GI upset, fatigue, muscle cramps | *GI upset, fatigue, muscle cramps | ||
*Can present with refractory seizures due to GABA deficiency | *[[Liver failure]] | ||
*[[Hypoglycemia]] | |||
*[[Rhabdomyolysis]] | |||
*Can present with refractory [[seizures]] due to GABA deficiency | |||
*Hemolysis usually mild | *Hemolysis usually mild | ||
*Rarely methemoglobinemia | *Rarely [[methemoglobinemia]] | ||
==Management== | ==Differential Diagnosis== | ||
{{Mushroom toxicity DDX}} | |||
==Evaluation== | |||
===Workup<ref>Tomková J, Ondra P, Válka I. Simultaneous determination of mushroom toxins α-amanitin, β-amanitin and muscarine in human urine by solid-phase extraction and ultra-high-performance liquid chromatography coupled with ultra-high-resolution TOF mass spectrometry. Forensic Sci Int. 2015 Jun. 251:209-13.</ref>=== | |||
*Blood sugar | |||
*BMP | |||
*LFT | |||
*Coags | |||
*CBC with differential | |||
*LDH, haptoglobin, reticulocyte | |||
*CK | |||
*MetHb level | |||
*Urine drug screen | |||
*[[Urinalysis]] | |||
==Management<ref>Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005 Feb. 33(2):427-36.</ref>== | |||
*Supportive care | *Supportive care | ||
*High dose pyridoxine for refractory seizures (5g IV initially) | *[[Dextrose]] boluses/infusions | ||
*Avoid phenobarbital, especially in liver failure | *High dose [[pyridoxine]] for refractory seizures (5g IV initially) <ref> Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175. </ref> | ||
*Methylene blue for severe methemoglobinemia | *Avoid [[phenobarbital]], especially in liver failure | ||
*Folinic acid supplementation (hydrazines inhibit MTHF production) | *[[Methylene blue]] for severe methemoglobinemia | ||
*Folinic acid ([[leucovorin]]) supplementation (hydrazines inhibit MTHF production) | |||
*Liver transplant for refractory hepatic failure | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
Latest revision as of 15:37, 8 February 2021
Background
- Also known as "brain fungi"
- Fruit in the spring and early summer
- Frequently mistaken for morel mushrooms[1]
- Inhibits formation of Vitamin B6 and GABA via hydrazine metabolite (similar to isoniazid toxicity)
Clinical Features
- GI upset, fatigue, muscle cramps
- Liver failure
- Hypoglycemia
- Rhabdomyolysis
- Can present with refractory seizures due to GABA deficiency
- Hemolysis usually mild
- Rarely methemoglobinemia
Differential Diagnosis
Mushroom toxicity by Type
| Mushroom | Toxin | Pathologic Effect |
| Amanita | Amatoxin | Hepatotoxicity |
| Coprine | Disulfiram-like | |
| Crotinarius | Orellanine | Delayed renal failure |
| Gyromitra | Gyromitrin | Seizures |
| Ibotenic Acid | Anticholinergic | |
| Muscarine | Cholinergic | |
| Orellanin | Nephrotoxicity | |
| Psilocybin | Hallucinations |
Evaluation
Workup[2]
- Blood sugar
- BMP
- LFT
- Coags
- CBC with differential
- LDH, haptoglobin, reticulocyte
- CK
- MetHb level
- Urine drug screen
- Urinalysis
Management[3]
- Supportive care
- Dextrose boluses/infusions
- High dose pyridoxine for refractory seizures (5g IV initially) [4]
- Avoid phenobarbital, especially in liver failure
- Methylene blue for severe methemoglobinemia
- Folinic acid (leucovorin) supplementation (hydrazines inhibit MTHF production)
- Liver transplant for refractory hepatic failure
Disposition
See Also
References
- ↑ Brozen R et al. Gyromitra Mushroom Toxicity. Apr 14, 2015. http://emedicine.medscape.com/article/817931-treatment#showall.
- ↑ Tomková J, Ondra P, Válka I. Simultaneous determination of mushroom toxins α-amanitin, β-amanitin and muscarine in human urine by solid-phase extraction and ultra-high-performance liquid chromatography coupled with ultra-high-resolution TOF mass spectrometry. Forensic Sci Int. 2015 Jun. 251:209-13.
- ↑ Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005 Feb. 33(2):427-36.
- ↑ Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175.