Hallucinogenic Mushroom Toxicity Clinical Presentation

  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jan 31, 2011
 

History

Hallucinogenic mushrooms usually are ingested for their psychoactive properties.[2]

Mushrooms containing ibotenic acid and muscimol

Symptoms begin 30 minutes to 1 hour postingestion; however, symptom onset rarely may be delayed as long as 3 hours.

Hallucinations may be accompanied by dysarthria, ataxia, and muscle cramps and may persist for as long as 8 hours. However, a recent case report describes an otherwise healthy 48-year-old man who accidentally ingested A muscaria mushrooms. He experienced a 5-day paranoid psychosis accompanied by visual and auditory hallucinations.[7] By the sixth day, he had returned to baseline, with no long-term adverse effects reported.

Central nervous system (CNS) effects range from agitation to coma.

Heavy intoxication may cause vomiting, diarrhea, and seizures.

Fatal A pantherina poisonings have been reported in the Pacific Northwest.[3, 8, 9]

Psilocybin-containing mushrooms

Alterations in perception begin within 30 minutes and subside after 6 hours.

Widely varying CNS manifestations, including euphoria, visual and religious hallucinations, and feeling closer to nature have been reported. Visual hallucinations may include perceived motion of stationary objects or surfaces.[10]

Patients presenting in the ED may experience more unpleasant effects such as fear, agitation, confusion, delirium, psychosis, and schizophrenialike syndromes.

Symptoms may include nausea and sympathomimetic activity such as mydriasis and tachycardia.

Symptoms in children include hyperpyrexia and seizures.

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Physical

Predominant findings in these intoxications are neurologic.

Fever, tachycardia, and hypotension may occur because of agitation.

Neurologic findings include the following:

  • Ataxia
  • Incoordination
  • Confusion
  • Delirium
  • Psychosis
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Contributor Information and Disclosures
Author

C Crawford Mechem, MD, MS, FACEP  Associate Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department

C Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Diane F Giorgi, MD, FACEP  Attending Physician, Department of Emergency Medicine, Brooklyn Hospital Center

Diane F Giorgi, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American Association of Women Emergency Physicians, American College of Emergency Physicians, and American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Clilton WS. The chemistry and mode of action of mushroom toxins. In: Spoerke DG, Rumack BH, eds. Handbook of Mushroom Poisoning. 2nd ed. CRC Press, LLC; 1994:165-223.

  2. McDonald A. Mushrooms and madness. Hallucinogenic mushrooms and some psychopharmacological implications. Can J Psychiatry. Nov 1980;25(7):586-94. [Medline].

  3. McPartland JM, Vilgalys RJ, Cubeta MA. Mushroom poisoning. Am Fam Physician. Apr 1997;55(5):1797-800, 1805-9, 1811-2. [Medline].

  4. Schwartz RH, Smith DE. Hallucinogenic mushrooms. Clin Pediatr (Phila). Feb 1988;27(2):70-3. [Medline].

  5. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance - United States, 2009. MMWR Surveill Summ. Jun 4 2010;59(5):1-142. [Medline].

  6. Rimsza ME, Moses KS. Substance abuse on the college campus. Pediatr Clin North Am. Feb 2005;52(1):307-19, xii. [Medline].

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

  8. Miller OK. Mushrooms of North America. Dutton; 1982:368.

  9. 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].

  10. Carter OL, Pettigrew JD, Burr DC, et al. Psilocybin impairs high-level but not low-level motion perception. Neuroreport. Aug 26 2004;15(12):1947-51. [Medline].

  11. Sticht G, Kaferstein H. Detection of psilocin in body fluids. Forensic Sci Int. Sep 11 2000;113(1-3):403-7. [Medline].

  12. Raff E, Halloran PF, Kjellstrand CM. Renal failure after eating "magic" mushrooms. CMAJ. Nov 1 1992;147(9):1339-41. [Medline].

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

  14. Goldfrank L, Flomenbaum N, Lewin N. Goldfrank's Toxicologic Emergencies. 4th ed. Appleton & Lange; 1990:575-85.

  15. Borowiak KS, Ciechanowski K, Waloszczyk P. Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction. J Toxicol Clin Toxicol. 1998;36(1-2):47-9. [Medline].

  16. Bickel M, Ditting T, Watz H, Roesler A, Weidauer S, Jacobi V. Severe rhabdomyolysis, acute renal failure and posterior encephalopathy after 'magic mushroom' abuse. Eur J Emerg Med. Dec 2005;12(6):306-8. [Medline].

  17. Hanes KR. Serotonin, psilocybin, and body dysmorphic disorder: a case report. J Clin Psychopharmacol. Apr 1996;16(2):188-9. [Medline].

  18. Riley SC, Blackman G. Between Prohibitions: Patterns and Meanings of Magic Mushroom Use in the UK. Subst Use Misuse. 2008;43(1):55-71. [Medline].

 
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