Gyromitra mushrooms

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Background

Gyromitra mushrooms
  • 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 Features

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

  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.
  4. Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175.

Authors:

Joe Carpenter