Mushroom toxicity

From WikEM
Jump to: navigation, search


Major Categories

  • Early-Onset Poisoning
    • Toxicity begins within 2hr of ingestion; clinical course is usually benign
  • Late-Onset Poisoning
    • Toxicity begins 6hr after ingestion; clinical course is often serious/ possibly fatal

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

Differential Diagnosis

Acute hepatitis


Early-Onset Poisoning

  • Comprises majority of mushroom-induced intoxications
  • Symptom onset 30-90 min with hallucinations, lasting 6-8 hrs[1]:
    • Isoxazoles (ibotenic acid and muscimol) - dsyarthria, ataxia, muscle cramps
    • Psilocybin - euphoria, visual hallucinations, agitation, sympathomimetic Sxs

Clinical Features

  • Depends on the type of mushroom ingested
  • GI
    • Nausea/vomiting/diarrhea
    • Resolves within 24hr
  • CNS
    • Euphoria, hallucinations
    • Lasts 4-6hr
  • Muscarinic
    • SLUDGE symptoms
    • Diaphoresis, muscle fasciculations, miosis, bradycardia, bronchorrhea
    • Resolves in 4-12hr
  • Disulfiram-like effect
    • Usually when drinking alcohol
    • Flushing, tachycardia, diaphoresis, hypotension


  • GI predominant symptoms:
    • Activated charcoal 0.5-1gm/kg
    • Do not give antidiarrheal meds
  • CNS predominant symptoms:
    • Place in dark, quiet room
    • Benzos may be given to patients who are agitated
    • Consider pyridoxine for refractory seizures, especially if suspecting gyromitra[2]
  • Muscarinic predominant symptoms:
    • Consider atropine for severe symptoms; 0.5-1mg IV for adults; 0.01mg/kg IV for peds


  • Discharge once symptoms have subsided

Delayed-Onset Poisoning

  • Amanita species causes 95% of deaths
    • Toxin inhibits formation of mRNA and is heat stable
    • Most frequent species: A. phalloides, bisporigera, magnivelaris, ocreata, verna, virosa[3]


  1. Rolston-Cregler L et al. Hallucinogenic Mushroom Toxicity. Apr 08, 2015.
  2. Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005;28(2):175.
  3. Enjalbert F et al. Treatment of Amatoxin Poisoning: 20 year retrospective analysis. J tox Clin Tox 2002 40(6):715-767.