Muscarine Mushroom Toxicity Workup

  • Author: Peter A Chyka, PharmD, FAACT, DABAT; Chief Editor: Timothy E Corden, MD   more...
 
Updated: May 27, 2011
 

Laboratory Studies

  • Several texts, such as Goldfrank's Toxicological Emergencies,[5] 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 fluid and electrolyte disturbances.
  • Urine drug screening should be considered, especially if the patient has unexplained behavioral changes; if suicidal intent, substance abuse, or foul play is suspected; or if ingestion of unknown toxins is suspected.
  • 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

  • Chest radiography may be helpful in evaluating pulmonary edema.
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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.
  • Obtain an electrocardiogram to evaluate the presence of atrioventricular (AV) nodal disease and heart block.
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Procedures

No particular diagnostic procedures are available or needed for most patients with toxicity from mushrooms containing muscarine.

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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

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.

References

  1. Benjamin DR. Muscarine poisoning. In: Mushrooms: Poisons and Panaceas. New York, NY: WH Freeman; 1995:340-50.

  2. Poisindex managements, mushrooms - muscarine / histamine. In: Poisindex System, internet database online [database online]. Greenwood Village (CO): Thomson Reuters (Healthcare); May 15, 2011.

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

  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, Griffin SL. 2009 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th annual report. Clin Toxicol. 2010;48:979-1178. [Full Text].

  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 May 17, 2011.

  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. [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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Inocybe geophylla.
Inocybe lacera.
Clitocybe dealbata.
Omphalotus olearius (jack o'lantern mushroom).
 
 
 
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