Psilocybin toxicity

Background

• A compound found in over 200 mushrooms that has mind altering properties similar to LSD.
• Commonly known as "magic mushrooms" or "shrooms". The mushroom are often taken recreationally for the euphoric and hallucinogenic effects. Typically grown in the Pacific Northwest and southern regions of the United States.
• For a typical dose (1mg) symptoms will last 1-3 hours.
• Low toxicity with LD50 of 280mg/kg
  • Therapeutic index = 641

Psilocybe semilanceata

Clinical Features

• Sensory/psychiatric
  • Euphoria
  • Visual hallucinations, synesthesia
  • Lethargy, Depression
  • Anxiety, agitation
  • Confusion, disorientation
  • Above may lead to accidental trauma
• Sympathetic effects
  • Mydriasis
  • Tachycardia
  • Hypertension
• Nausea
• Hypotension

Differential Diagnosis

• Hypoglycemia
• TBI
• CO poisoning
• Meningitis/Encephalitis
• Opioid intoxication
• Antihistamines/Anticholinergic toxicity

Drugs of abuse

• 25C-NBOMe‎
• Alcohol
• Amphetamines
• Bath salts
• Cocaine
• Ecstasy
• Gamma hydroxybutyrate (GHB)
• Heroin
• Inhalant abuse
  • Hydrocarbon toxicity
  • Difluoroethane (electronics duster)
• Marijuana
• Kratom
• Phencyclidine (PCP)
• Psilocybin ("magic mushrooms")
• Synthetic cannabinoids
• Chloral hydrate
• Body packing

Hallucinations

Serotonin-Like Agents

• Lysergic acid diethylamide (LSD)
• Psilocybin ("magic mushrooms")
• N,N-Dimethyltryptamine (DMT)
• 5-methoxy- dimethyltryptamine (5-MeO-DMT)
• 25C-NBOMe

Enactogens

• Designer amphetamines
• Bath salts
• Ecstasy (MDMA)
• Mescaline (peyote)
• Synthetic cannabinoids

Dissociative Agents

• Phencyclidine (PCP)
• Ketamine
• Dextromethorphan
• Nitrous oxide

Plant-based Hallucinogenics

• Marijuana
• Salvia
• Absinthe
• Isoxazole Mushrooms
• Hawaiian baby woodrose (Argyreia nervosa)
• Hawaiian woodrose (Merremia tuberosa)
• Morning glory (Ipomoea violacea)
• Olili- uqui (Rivea corymbosa)

Organic causes

• Delirium
• Intracranial mass to occipital or temporal lobes
• Encephalitis, limbic encephalitis, anti-NMDA receptor encephalitis
• Migraine
• Seizure
• Hypocalcemia/Hypercalcemia
• Rift valley fever
• Rabies
• Syphilis
• Vitamin B7 deficiency
• Pellagra
• Dementia
  • Parkinson's Disease

Other Toxicologic Causes

• Alcohol withdrawal
• Anticholinergic Toxicity
• Tricyclic (TCA) Toxicity
• Synthetic cannabinoids
• Inhalant abuse
• Nitrogen narcosis
• GHB withdrawal
• Hydrocarbon toxicity
• Heavy metal toxicity
• Multiple medications: montelukast, doxapram, hyoscyamine, tizanidine, peramivir, amantadine, rimantadine, bromocriptine, methylergonovine, benztropine, doxepin, voriconazole, acyclovir, valacyclovir, ganciclovir, cimetidine, penicillin G Procaine, clarithromycin, metoclopramide
• Inhalant abuse

Psychiatric Causes

• Schizophrenia, schizoaffective disorder, schizophreniform disorder
• Depression with psychotic features
• Bipolar disorder
• Charles Bonnet Syndrome (in the visually impaired)

Evaluation

• Clinical diagnosis
• Urine drug screen if concerned about co-ingestion

Management

• Supportive care
• Place patient in a calm and quiet environment
• Benzodiazepines for worsening tachycardia/hypertension or agitation

Disposition

• Discharge when vitals normalize and clinically sober

See Also

• Mushroom toxicity
• Drugs of abuse