Management of mushroom poisoning
- Timothy J Wiegand, MD, DABAM, FACMT, FAACT
Timothy J Wiegand, MD, DABAM, FACMT, FAACT
- Director of Medical Toxicology and Toxicology Consult Service
- Associate Clinical Professor of Emergency Medicine
- URMC and Strong Memorial Hospital
- Section Editors
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Ingestion of potentially poisonous mushrooms occurs frequently, but serious toxicity is uncommon. There are 12 groups of identified mushroom toxins with 14 described clinical syndromes (table 1). Defining which clinical syndrome predominates, initiating general supportive care, and administering any specific treatments for that syndrome are the key steps in the initial management for mushroom ingestion [1,2].
The general management of mushroom poisoning is reviewed here. The clinical manifestations and diagnosis of mushroom poisoning, and the diagnosis and treatment of poisoning caused by mushrooms containing potentially lethal cyclopeptide toxins (eg, amatoxin) and by Amanita smithiana are discussed in greater detail separately. (See "Clinical manifestations and evaluation of mushroom poisoning" and "Amanita smithiana mushroom poisoning" and "Amatoxin-containing mushroom poisoning (eg, Amanita phalloides): Clinical manifestations, diagnosis, and treatment".)
AMATOXIN-CONTAINING MUSHROOM POISONING
Management of amatoxin-containing mushroom poisoning is covered in greater detail separately. (See 'General management' below.)
A regional poison control center should be contacted to discuss likely mushroom species ingested based upon clinical findings, identification of any mushrooms available for analysis, and treatment of specific toxic effects. Most poison control centers maintain active call lists of mycologists who are knowledgeable concerning local prevalence of mushroom genera and species and can assist in mushroom identification. To obtain emergent consultation with a medical toxicologist, call the United States Poison Control Network at 1-800-222-1222, or access the World Health Organization's list of international poison centers (www.who.int/gho/phe/chemical_safety/poisons_centres/en/index.html).
Supportive care and gastrointestinal decontamination with activated charcoal suffice for proper management of most patients with mushroom poisoning .
- Goldfrank LR. Mushrooms. In: Goldfrank's Toxicologic Emergencies, 9th ed, Nelson LS, Lewin NA, Howland MA, et al. (Eds), McGraw-Hill, New York 2011. p.1522.
- Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. Clin Toxicol (Phila) 2009; 47:911.
- Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med 2005; 28:175.
- Berger KJ, Guss DA. Mycotoxins revisited: Part I. J Emerg Med 2005; 28:53.
- Diaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med 2005; 33:419.
- Brent J, Palmer RB. Mushrooms. In: Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose, 4th ed, Shannon MW, Borron SW, Burns MJ (Eds), Saunders Elsevier, Philadelphia, PA 2007. p.455.
- Benjamin DR. Mushroom poisoning in infants and children: the Amanita pantherina/muscaria group. J Toxicol Clin Toxicol 1992; 30:13.
- Satora L, Pach D, Butryn B, et al. Fly agaric (Amanita muscaria) poisoning, case report and review. Toxicon 2005; 45:941.
- Beuhler MC, Sasser HC, Watson WA. The outcome of North American pediatric unintentional mushroom ingestions with various decontamination treatments: an analysis of 14 years of TESS data. Toxicon 2009; 53:437.
- Michelot D, Toth B. Poisoning by Gyromitra esculenta--a review. J Appl Toxicol 1991; 11:235.
- Pauli JL, Foot CL. Fatal muscarinic syndrome after eating wild mushrooms. Med J Aust 2005; 182:294.
- Bedry R, Baudrimont I, Deffieux G, et al. Wild-mushroom intoxication as a cause of rhabdomyolysis. N Engl J Med 2001; 345:798.
- West PL, Lindgren J, Horowitz BZ. Amanita smithiana mushroom ingestion: a case of delayed renal failure and literature review. J Med Toxicol 2009; 5:32.
- Danel VC, Saviuc PF, Garon D. Main features of Cortinarius spp. poisoning: a literature review. Toxicon 2001; 39:1053.
- Nakajima N, Ueda M, Higashi N, Katayama Y. Erythromelalgia associated with Clitocybe acromelalga intoxication. Clin Toxicol (Phila) 2013; 51:451.
- Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med 2005; 33:427.
- AMATOXIN-CONTAINING MUSHROOM POISONING
- GENERAL MANAGEMENT
- Supportive care
- - Vomiting and diarrhea
- - Agitation, delirium, and/or hallucinations
- - Seizures
- - Cholinergic excess
- - Rhabdomyolysis
- - Liver failure
- - Renal failure
- - Erythromelalgia
- Shitake dermatitis
- Gastrointestinal decontamination
- Elimination enhancement
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS