Ibotenic Acid Mushroom Toxicity Medication

  • Author: Peter A Chyka, PharmD, FAACT, DABAT; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Jun 1, 2011
 

Medication Summary

Most patients with poisoning due to ibotenic acid mushrooms can be treated without medications. If patients are severely agitated, anxiolytics may be needed. For seizures lasting longer than 5 minutes, various anticonvulsants have been used. If the patient presents within 1 hour of ingestion, oral administration of activated charcoal may be considered,[17] but adsorption to activated charcoal has not been demonstrated for these constituents.[18] No evidence suggests that routine administration of multiple doses of activated charcoal is useful.

Ipecac syrup should generally be avoided because of the relatively rapid onset of CNS symptoms after ingestion of ibotenic acid mushrooms and evidence for its effectiveness is lacking. Although these mushrooms are named A muscaria, few muscarinic effects are observed and anticholinergic drugs such as atropine are rarely, if ever, needed.

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Benzodiazepine

Class Summary

Benzodiazepines are first-line agents for controlling seizures in patients with toxicity. They are also helpful in sedating patients with extreme agitation.

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Diazepam (Valium)

 

Useful for agitation or seizures. Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

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Lorazepam (Ativan)

 

Useful for agitation or seizures. By increasing action of GABA (major inhibitory neurotransmitter in brain), may depress all levels of CNS, including limbic and reticular formation.

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Midazolam (Versed)

 

Used as alternative in termination of refractory status epilepticus. Because midazolam is water soluble, it takes approximately 3 times longer than diazepam to achieve peak EEG effects; wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose.

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Contributor Information and Disclosures
Author

Peter A Chyka, PharmD, FAACT, DABAT  Professor and Executive Associate Dean, College of Pharmacy, University of Tennessee Health Science Center

Peter A Chyka, PharmD, FAACT, DABAT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Clinical Pharmacy, and American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Coauthor(s)

William Banner Jr, MD, PhD  Medical Director, Oklahoma Poison Control Center; Clinical Professor of Pharmacy, Oklahoma University College of Pharmacy-Tulsa; Adjunct Clinical Professor of Pediatrics, Oklahoma State University College of Osteopathic Medicine

William Banner Jr, MD, PhD, is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Mullins, MD  Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD  Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center

Disclosure: Merck Salary Employment

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

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  2. Berger KJ, Guss DA. Mycotoxins revisited: Part II. J Emerg Med. 2005b Feb;28(2):175-83. [Medline].

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  9. Benjamin DR. Mushroom poisoning in infants and children: the Amanita pantherina/muscaria group. J Toxicol Clin Toxicol. 1992;30(1):13-22. [Medline].

  10. Poisindex managements, mushrooms - muscimol / ibotenic acid. In: Poisindex System [Internet database online] [database online]. Greenwood Village (CO): Thomson Reuters (Healthcare); May 17, 2011.

  11. Brvar M, Mozina M, Bunc M. Prolonged psychosis after Amanita muscaria ingestion. Wien Klin Wochenschr. May 2006;118(9-10):294-7. [Medline].

  12. Satora L, Pach D, Butryn B, Hydzik P, Balicka-Slusarczyk B. Fly agaric (Amanita muscaria) poisoning, case report and review. Toxicon. Jun 1 2005;45(7):941-3. [Medline].

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  14. NAMA (North American Mycological Association). Annual reports. North American Mycological Association, Toxicology Section. Available at http://www.namyco.org/toxicology. Accessed May 17, 2011.

  15. West PL, Lindgren J, Horowitz BZ. Amanita smithiana mushroom ingestion: a case of delayed renal failure and literature review. J Med Toxicol. Mar 2009;5(1):32-8. [Medline].

  16. Fischbein CB, Mueller GM, Leacock PR, Wahl MS, Aks SE. Digital imaging: a promising tool for mushroom identification. Acad Emerg Med. Jul 2003;10(7):808-11. [Medline].

  17. 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. Mar 15 2009;53(4):437-43. [Medline].

  18. [Best Evidence] [Guideline] Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61-87. [Medline]. [Full Text].

 
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Fly agaric (Amanita muscaria).
Amanita pantherina.
Amanita muscaria.
Amanita muscaria var. guessowii with a yellow cap surface, Massachusetts.
Amanita muscaria var. formosa sensu, Thiers, Oregon.
 
 
 
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