eMedicine Specialties > Emergency Medicine > Toxicology

Toxicity, Mushroom - Muscarine: Follow-up

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

Updated: Oct 14, 2009

Follow-up

Further Inpatient Care

  • Administer intravenous fluids if vomiting becomes prominent, although this is rare.
  • Provide psychiatric care to patients with intentional ingestions and suicidal thinking.

Deterrence/Prevention

  • Avoid eating mushrooms that are not commercially cultivated for human consumption.
  • Cautious mushroom hunters eat only one type of mushroom and save a sample in a dry, paper bag for later identification, if needed.
    • Identification of mushrooms is best left to experts.
    • Prevention is best achieved by eating only commercially cultivated mushrooms.
  • Regularly remove mushrooms from sites where children are routinely present.

Prognosis

  • The prognosis is excellent because many patients who ingest these mushrooms exhibit minor or no symptoms. Symptoms are typically self-limited, and patients recover without drug therapy. If needed, atropine relives most significant muscarinic symptoms.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Martin I Herman, MD, to the development and writing of this article.



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References
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References

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  2. Poisindex managements, mushrooms – muscarine / histamine. In: Poisindex System, internet database online [database online]. Greenwood Village (CO): Thomson Reuters (Healthcare); February 27, 2009.

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

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

  5. Goldfrank LR. Mushrooms. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin NA, Nelson LS. Goldfrank's Toxicologic Emergencies. 8th. New York: McGraw-Hill; 2006:1564-76.

  6. 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].

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

  8. Bronstein AC, Spyker DA, Cantilena Jr LR, Green JL, Rumack BH, Heard SE. 2007 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th annual report. Clin Toxicol. 2008;46:927-1057.

  9. Pauli JL, Foot CL. Fatal muscarinic syndrome after eating wild mushrooms. Med J Aust. Mar 21 2005;182(6):294-5. [Medline].

  10. NAMA (North American Mycological Association). Annual reports. North American Mycological Association, Toxicology Section. Available at http://www.namyco.org/toxicology. Accessed March 4, 2009.

  11. 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].

  12. 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].

  13. 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;53:437-43.

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

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Further Reading

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Keywords

muscarine, mushroom poisoning, mushroom poisoning symptoms, cholinergic syndrome, jack o'lantern mushroom, sweating mushroom

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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.

Medical Editor

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

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Jeffrey R Tucker, MD, Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center
Jeffrey R Tucker, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Pediatrics, and Massachusetts Medical Society
Disclosure: Merck Salary Employment

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

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.

 
 
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