Hallucinogenic Mushroom Toxicity Treatment & Management

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

Prehospital Care

Prehospital care primarily is supportive with attention to ABCs.

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Emergency Department Care

ED care is primarily supportive.[14]

Consider gastric lavage if ingestion occurred within approximately 1 hour of presentation. However, no data exist to support efficacy in this setting.

Consider activated charcoal.

Provide agitated patients with a quiet nonthreatening environment.

Consider intravenous fluids if signs of volume depletion are present.

Do not treat fever with antipyretics; fever probably is caused by agitation and increased motor activity.

Benzodiazepines may be used for sedation and treatment of panic attacks, hallucinations, and seizures.

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Consultations

The regional poison control center may be contacted for consultation, referral, and, if necessary, assistance in mushroom identification. A nationwide telephone number, 1-800-222-1222, is now available. Calls will be automatically directed to the nearest poison control center.

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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].

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  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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