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Hallucinogenic Mushroom Toxicity Treatment & Management

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

Approach Considerations

Prehospital care is primarily supportive, with appropriate attention paid to the ABCs (a irway, b reathing, c irculation). Emergency department (ED) care is primarily supportive as well.[34]

The entire poisoning episode usually subsides in 6-8 hours; some symptoms may take up to several days to fully resolve. Benzodiazepines may be used for sedation and treatment of panic attacks, hallucinations, and seizures. Psychiatric consultation and evaluation may be needed for persistent psychotic symptoms.[3]

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Supportive Measures

Symptomatic patients may be treated with supportive measures, including the following:

  • Consider gastric lavage if ingestion occurred within approximately 1 hour of presentation (though there are no data to support the efficacy of the procedure in this setting)
  • Consider oral administration of activated charcoal if the patient presents within 1 hour of ingestion[35] ; however, adsorption to activated charcoal has not been demonstrated for these constituents,[36] and there is no evidence that routine administration of multiple doses of activated charcoal is useful
  • Consider administering intravenous (IV) fluids if vomiting becomes prominent (a rare occurrence) or signs of volume depletion are present
  • Provide agitated patients with a quiet, nonthreatening environment.
  • Provide psychiatric care to patients with intentional ingestions and suicidal thinking

With good supportive care, most patients recover within 6-8 hours and may be discharged from the ED at that time, provided no complicating issues are present and they have a safe environment to which to return.

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Pharmacologic Therapy

Most patients with poisoning due to ibotenic acid−containing mushrooms can be treated without medications. If patients are severely agitated, anxiolytics (eg, benzodiazepines) may be needed. For seizures lasting longer than 5 minutes, various anticonvulsants have been used. It should be kept in mind that respiratory depression has been reported when these agents are administered IV. Preparations must therefore be made to support the airway if necessary.[14]

Ipecac syrup should generally be avoided. Central nervous system (CNS) symptoms develop relatively rapidly after ingestion of ibotenic acid−containing mushrooms, and evidence for the effectiveness of ipecac in this setting is lacking.

With A muscaria poisoning, despite the implications of the species name, few muscarinic effects are observed; consequently, anticholinergic drugs such as atropine are rarely, if ever, needed.

Fever in this setting should not be treated with antipyretics; it is probably the result of agitation and increased motor activity.

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Prevention

Cautious mushroom hunters eat only 1 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 achieved by eating only mushrooms that are commercially cultivated for human consumption. Mushrooms should be regularly removed from sites where children are routinely present.

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Consultations

A mycologist should be consulted to assist with mushroom identification. 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 available in the United States; calls to this number are automatically directed to the nearest poison control center. A mycologist can also be contacted through a mycology club, the North American Mycological Association (NAMA), a botanical garden, or a local university.

Consultation with a medical toxicologist may be helpful, if available. Consultation with a psychiatrist is advisable when the patient may have had suicidal intent.

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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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