Gyromitra mushrooms

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Gyromitra mushrooms

Overview

  • 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

Clinical findings

  • GI upset, fatigue, muscle cramps
  • Liver failure
  • Hypoglycemia
  • Rhabdomyolysis
  • Can present with refractory seizures due to GABA deficiency
  • Hemolysis usually mild
  • Rarely methemoglobinemia

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)
  • Avoid phenobarbital, especially in liver failure
  • Methylene blue for severe methemoglobinemia
  • Folinic acid supplementation (hydrazines inhibit MTHF production)
  • Liver transplant for refractory hepatic failure

See Also

References

  1. ↑ Brozen R et al. Gyromitra Mushroom Toxicity. Apr 14, 2015. http://emedicine.medscape.com/article/817931-treatment#showall.
  2. ↑ 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.
  3. ↑ Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005 Feb. 33(2):427-36.
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