Gyromitra Toxin Toxicity Clinical Presentation

  • Author: Reed Brozen, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Nov 17, 2011
 

History

Determining history of mushroom exposure is helpful. Query patients presenting with gastroenteritis about mushroom collecting, cooking, and ingestion.

  • Onset of symptoms typically is delayed with gyromitrin poisoning.
    • GI symptoms typically occur 6-10 hours after ingestion; however, symptoms may begin earlier with severe poisonings.
    • Symptoms may be delayed 48 hours with mild poisonings.
    • Inhalation exposure characteristically produces symptoms within 2 hours of exposure.
    • GI phase of toxicity may be followed by neurologic and hepatorenal toxicity.
  • Details of ingestion and progression of symptoms are helpful in differentiating ingestions of different mushroom types. Ask the following questions to ascertain specific history:
    • When were the mushrooms ingested (or when was patient exposed to vapors of cooking mushrooms)?
    • When did each symptom begin?
    • Where were the mushrooms found?
    • Were other species ingested?
    • Did others become ill after eating the mushrooms?
  • Clinical history includes the following:
    • GI symptoms are prominent, with complaints of abdominal pain, bloating, vomiting, and diarrhea.
    • Other complaints (eg, weakness, dizziness, headache, confusion, seizures) may be caused by volume depletion, anemia, and renal, hepatic, or neurologic toxicity.
    • Typical duration of symptoms is 1-2 days but may be as long as 5 days.
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Physical

  • Vital signs
    • Tachycardia
    • Hypotension
    • Tachypnea (secondary to methemoglobinemia and/or hemolysis)
    • Fever
  • General appearance
    • Dry skin with poor turgor (from vomiting and fluid losses)
    • Pale skin (from hemolysis)
    • Cyanosis unresponsive to oxygen (from methemoglobinemia)
    • Jaundice (from liver damage and hemolysis)
  • Neurologic findings
    • Tremor, muscle spasms
    • Seizures, delirium
    • Stupor and encephalopathy
  • Abdominal and rectal findings
    • Hyperactive bowel sounds, bloating, mild tenderness to palpation
    • Hepatomegaly
    • Liquid or heme-positive stool
  • Hematologic findings
    • Muddy-colored urine from hemoglobinuria (due to hemolysis)
    • Chocolate-colored brown blood (from methemoglobinemia)
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Causes

MMH poisoning may occur after ingestion of fresh, dried, or raw gyromitrin-containing mushrooms or with inhalation of vapors while cooking gyromitrin-containing mushrooms.

  • Severity depends on amount of toxin ingested. Amount of toxin greatly varies among mushrooms, and significant variation in individual susceptibility exists.
    • Raw mushrooms have more toxin than cooked mushrooms.
    • Fresh mushrooms have more toxin than dry mushrooms.
    • Environmental factors appear to influence the amount of toxin, which varies regionally in these mushrooms. Michigan has a large number of Gyromitra mushrooms.
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Contributor Information and Disclosures
Author

Reed Brozen, MD  Director of Air Transport, Associate Professor, Department of Emergency Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center

Reed Brozen, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, New Hampshire Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Marcus J Hampers, MD, MBA  Instructor, Department of Medicine, Dartmouth Medical School; Consulting Staff, Department of Internal Medicine, Section of Hospital Medicine, Department of Anesthesiology, Section of Critical Care Medicine, and Department of Emergency Medicine, Dartmouth Hitchcock Medical Center

Marcus J Hampers, MD, MBA is a member of the following medical societies: American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Medical Association, New Hampshire Medical Society, Society of Critical Care Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

B Zane Horowitz, MD, FACMT  Professor, Department of Emergency Medicine, Oregon Health and Sciences University; Medical Director, Oregon Poison Center; Medical Director, Alaska Poison Control System

B Zane Horowitz, MD, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Medical Toxicology

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and 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

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