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Toxicity, Mushroom - Gyromitra Toxin: Differential Diagnoses & Workup

Author: Reed Brozen, MD, Director of Air Transport, Associate Professor, Department of Emergency Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center
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
Contributor Information and Disclosures

Updated: Feb 29, 2008

Differential Diagnoses

Cholelithiasis
Toxicity, Disulfiram
Gastritis and Peptic Ulcer Disease
Toxicity, Iron
Gastroenteritis
Toxicity, Isoniazid
Giardiasis
Toxicity, Mushroom - Amatoxin
Hepatitis
Toxicity, Mushroom - Disulfiramlike Toxins
Methemoglobinemia
Toxicity, Mushroom - Orellanine
Pediatrics, Gastroenteritis
Toxicity, Organophosphate and Carbamate
Plant Poisoning, Hypoglycemics
Toxicity, Valproate
Pregnancy, Hyperemesis Gravidarum
Salmonella Infection
Toxicity, Acetaminophen

Other Problems to Be Considered

Shigellosis

Workup

Laboratory Studies

  • Electrolytes, BUN, creatinine, and glucose
    • Patients often are dehydrated.
    • Assess renal function of patients with hemolysis.
    • Hyperglycemia may be present as an acute stress reaction; however, sudden hypoglycemia is a greater concern than hyperglycemia with hepatic injury.
  • Complete blood count and/or peripheral blood smear: Assess for anemia from hemolysis or blood loss.
  • Hepatic transaminases and serum bilirubin
    • Findings may be normal at presentation; however, if hepatic injury exists it becomes abnormal within days of exposure.
    • Bilirubin may be elevated from hemolysis or liver toxicity.
  • Methemoglobin levels: Measure by co-oximetry (determine need for methylene blue treatment).
  • Tests for hemolysis
    • Urinalysis: Positive dip test for blood without RBCs on microscopic analysis suggests either hemolyzed blood (hemoglobinuria) or myoglobin.
    • Free plasma hemoglobin increases with hemolysis.
    • Serum haptoglobin decreases with hemolysis.
    • Blood smears: Heinz body formation is observed with special stains, and bite cells are observed with Wright stain.

Other Tests

  • Determination of mushroom type
    • If a specimen of the ingested mushroom is available, save it in a paper bag for potential identification. An experienced mycologist may identify the mushroom.
    • Save any food specimen or gastric contents (from emesis); further testing for gyromitrin toxin occasionally may be performed.
  • Gas-liquid chromatography, gas mass spectrometry, and thin-layer chromatography can be used to identify hydrazone and hydrazine compounds.

More on Toxicity, Mushroom - Gyromitra Toxin

Overview: Toxicity, Mushroom - Gyromitra Toxin
Differential Diagnoses & Workup: Toxicity, Mushroom - Gyromitra Toxin
Treatment & Medication: Toxicity, Mushroom - Gyromitra Toxin
Follow-up: Toxicity, Mushroom - Gyromitra Toxin
References
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References

  1. Watson WA, Litovitz TL, Rodgers GC, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2005;23(5):589-666. [Medline].

  2. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2004;22(5):335-404. [Medline].

  3. Watson WA, Litovitz TL, Rodgers GC, et al. 2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2003;21(5):353-421. [Medline].

  4. Litovitz TL, Klein-Schwartz W, Rodgers GC, et al. 2001 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2002;20(5):391-452. [Medline].

  5. Litovitz TL, Klein-Schwartz W, White S, et al. 2000 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2001;19(5):337-95. [Medline].

  6. Litovitz TL, Klein-Schwartz W, White S, et al. 1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 2000;18(5):517-74. [Medline].

  7. Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1999;17(5):435-87. [Medline].

  8. Litovitz TL, Klein-Schwartz W, Dyer KS, et al. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1998;16(5):443-97. [Medline].

  9. Litovitz TL, Smilkstein M, Felberg L, et al. 1996 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. Sep 1997;15(5):447-500. [Medline].

  10. Hoppe-Roberts JM, Lloyd LM, Chyka PA. Poisoning mortality in the United States: comparison of national mortality statistics and poison control center reports. Ann Emerg Med. May 2000;35(5):440-8. [Medline].

  11. Braun R, Greeff U, Netter KJ. Liver injury by the false morel poison gyromitrin. Toxicology. Feb 1979;12(2):155-63. [Medline].

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  13. Karlson-Stiber C, Persson H. Cytotoxic fungi--an overview. Toxicon. Sep 15 2003;42(4):339-49. [Medline].

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  15. Michelot D, Toth B. Poisoning by Gyromitra esculenta--a review. J Appl Toxicol. Aug 1991;11(4):235-43. [Medline].

  16. Schneider A, Attaran M, Meier PN, Strassburg C, Manns MP, Ott M. Hepatocyte transplantation in an acute liver failure due to mushroom poisoning. Transplantation. Oct 27 2006;82(8):1115-6. [Medline].

  17. Trestrail JH. Monomethylhydrazine-containing mushrooms. In: Spoerke DG, Rumack BH, eds. Handbook of Mushroom Poisoning: Diagnosis and Treatment. CRC Press LLC; 1994:279-87.

  18. Yildirim C, Bayraktaroglu Z, Gunay N, Bozkurt S, Köse A, Yilmaz M. The use of therapeutic plasmapheresis in the treatment of poisoned and snake bite victims: an academic emergency department's experiences. J Clin Apher. Dec 2006;21(4):219-23. [Medline].

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Further Reading

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Keywords

mushroom poisoning, false morel mushrooms, Gyromitra esculenta, Gyromitra ambigua, Gyromitra infula, mushroom toxicity, gyromitra toxin, gyromitra poisoning, hydrazones, N -methyl-N-formylhydrazone, mushroom exposure, gyromitrin-containing mushrooms, poisonous 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.

Medical Editor

B Zane Horowitz, MD, FACMT, Professor, Fellowship Director, 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.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
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