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Hallucinogenic Mushroom Toxicity Medication

  • Author: Louis Rolston-Cregler, MD; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Apr 08, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity, to prevent complications, and to neutralize the mushroom toxin (ibotenic acid, muscimol, psilocybin, or psilocin). Agents used include gastrointestinal (GI) decontaminants and benzodiazepines.

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GI decontaminants

Class Summary

Activated charcoal is preferred when GI decontamination is desired.

Activated charcoal (Liqui-Char)

 

Activated charcoal is most useful if administered within 2 hours of ingestion. Outcome data are limited, especially when the agent is given more than 1 hour after ingestion. Administration of charcoal by itself (in aqueous solution), as opposed to coadministration with a cathartic, is the current practice standard for the following reasons:

• No studies have shown benefit from cathartics in this setting

• Whereas most drugs and toxins are adsorbed within 30-90 minutes, laxatives take hours to work

• Dangerous fluid and electrolyte shifts have occurred when cathartics are used in small children

When the ingested dose is known, charcoal may be given at 10 times the ingested dose in either 1 or 2 doses. For maximum effect, administer within 30 minutes of poison ingestion.

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Benzodiazepines

Class Summary

Benzodiazepines are first-line agents for preventing seizure recurrence and terminating clinical and electrical seizure activity in patients with toxicity. They are also helpful in sedating patients with extreme agitation.

Diazepam (Valium)

 

Diazepam depresses all levels of the central nervous system (CNS), including the limbic system and the reticular formation, possibly by increasing the activity of gamma-aminobutyric acid (GABA). To avoid adverse effects, individualize the dosage and increase it cautiously.

Lorazepam (Ativan)

 

Lorazepam is useful for agitation or seizures and is the drug of choice for treatment of status epilepticus (because it persists in the CNS longer than diazepam does). By increasing the action of GABA (a major inhibitory neurotransmitter in the brain), it may depress all levels of the CNS, including the limbic system and the reticular formation. The rate of injection should not exceed 2 mg/min. Lorazepam may be administered intramuscularly (IM) if vascular access cannot be obtained.

Midazolam (Versed)

 

Midazolam is used as an alternative for terminating refractory status epilepticus. Because it is water-soluble, it takes approximately 3 times longer to achieve peak electroencephalographic (EEG) effects than diazepam does. Thus, the clinician must wait 2-3 minutes to evaluate its sedative effects fully before initiating a procedure or repeating the dose. Midazolam has twice the affinity for benzodiazepine receptors that diazepam does. It may be administered IM if vascular access cannot be obtained.

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Contributor Information and Disclosures
Author

Louis Rolston-Cregler, MD Resident Physician, Department of Emergency Medicine, SUNY Downstate Medical Center, Kings County Hospital Center

Louis Rolston-Cregler, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association, Student National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Sage W Wiener, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center

Sage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, 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.

Acknowledgements

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.

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.

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.

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.

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.

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.

C Crawford Mechem, MD, MS, FACEP 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.

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

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

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.

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.

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