Ibotenic Acid Mushroom Toxicity Workup

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

Laboratory Studies

  • Several texts, such as Goldfrank's Toxicological Emergencies,[3] describe how to determine if the suspect botanical contains amatoxin, a potent toxin found in some of the Amanita species. However, for symptomatic patients, identification of the mushroom by a mycologist is desirable. (See Consultations.)
  • Obtain a complete blood count because some mushroom toxins (eg, gyromitrin) can cause hemolytic anemia.
  • Baseline liver function studies are indicated because possible ingestion of other toxic mushrooms, such as cyclopeptide-type mushrooms, can cause hepatotoxicity.
  • Baseline renal function studies are indicated because some mushrooms are nephrotoxic, such as Amanita smithiana( in Northwestern US) and orelline mushrooms.
  • Consider evaluation for rhabdomyolysis if signs and symptoms warrant because some mushrooms, Tricholoma equestre, may cause muscle toxicity.
  • Obtain a basic serum metabolic profile (sodium, potassium, chlorine, carbon dioxide, creatinine, glucose, and calcium) to evaluate for fluid and electrolyte disturbances due to other offending ingestants.
  • Urine drug screening should be considered, especially if the patient has unexplained symptoms or behavioral changes, if suicidal intent, substance abuse or foul play is suspected, or if ingestion of unknown toxins is suspected.
  • The patient's urine may be analyzed for muscimol to confirm muscimol poisoning, but this test is not typically available in hospital laboratories.
  • Chromatographic techniques (eg, thin-layer chromatography [TLC], gas-liquid chromatography [GLC], high-pressure liquid chromatography [HPLC]) are available to detect amanitins, orellanine, muscimol and ibotenic acid, psilocybin, muscarine, and the gyromitrins. However, these techniques are typically unavailable to the general practitioner because they are limited to laboratories conducting research on these compounds.
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Imaging Studies

  • If the diagnosis is uncertain, and if blunt head trauma is part of the differential diagnosis because of changes in mental status, obtain a plain CT scan of the head before lumbar puncture is performed.
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Other Tests

  • Gastric contents may be examined. A mycologist may be able to microscopically identify the spores recovered from the patient's gastric contents.
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Procedures

  • No particular diagnostic procedures are available or needed for most patients with toxicity from mushrooms containing muscimol or ibotenic acid.
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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

  1. Berger KJ, Guss DA. Mycotoxins revisited: Part I. J Emerg Med. Jan 2005;28(1):53-62. [Medline].

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

  3. Goldfrank LR. Mushrooms. In: Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE. Goldfrank's Toxicologic Emergencies. 9th ed. New York: McGraw-Hill; 2011:1522-36.

  4. Diaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med. Feb 2005;33(2):419-26. [Medline].

  5. Diaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. Feb 2005;33(2):427-36. [Medline].

  6. Watson WA, Litovitz TL, Rodgers GC Jr, Klein-Schwartz W, Reid N, Youniss J, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2005;23(5):589-666. [Medline]. [Full Text].

  7. Michelot D, Melendez-Howell LM. Amanita muscaria: chemistry, biology, toxicology, and ethnomycology. Mycol Res. Feb 2003;107(Pt 2):131-46. [Medline].

  8. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Griffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). 2010;48:979-1178. [Full Text].

  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].

  13. Satora L, Pach D, Ciszowski K, Winnik L. Panther cap Amanita pantherina poisoning case report and review. Toxicon. Apr 2006;47(5):605-7. [Medline].

  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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