Further Inpatient Care
- Admit all symptomatic patients in whom gyromitrin poisoning is suspected for further management and monitoring.
- Monitor patients for dehydration, neurologic toxicity, and liver or renal failure.
Further Outpatient Care
- Patients with gyromitrin ingestion who seek medical care, are asymptomatic 8 hours after ingestion, and are without clinical or laboratory signs of toxicity may be considered for discharge.
- Early follow-up care for reevaluation must be in place at the time of discharge. Instruct patients to return immediately if they become symptomatic.
- Instruct patients to keep themselves well hydrated.
Transfer
- Consider patients who have developed seizures, coma, severe methemoglobinemia, or hemolysis for intensive care unit admission.
Complications
- Aspiration pneumonia
- Rhabdomyolysis
- Renal failure secondary to hemolysis and rhabdomyolysis
- Liver failure
- Anoxic and hepatic encephalopathy
Prognosis
- Most patients fully recover after 2-5 days of a gastric illness.
- Death from Gyromitra species is rare in North America.
Patient Education
- Inform patients that Gyromitra mushrooms are toxic and potentially lethal.
- For excellent patient education resources, visit eMedicine's Poisoning Center and Poisoning - First Aid and Emergency Center. Also, see eMedicine's patient education articles Poisoning and Activated Charcoal.
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].
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].
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].
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].
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].
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].
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].
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].
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].
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].
Braun R, Greeff U, Netter KJ. Liver injury by the false morel poison gyromitrin. Toxicology. Feb 1979;12(2):155-63. [Medline].
Brent J, Kulig K. Mushrooms. In: Haddad LM, et al, eds. Clinical Management of Poisoning and Drug Overdose. 3rd ed. WB Saunders; 1998:365-74.
Karlson-Stiber C, Persson H. Cytotoxic fungi--an overview. Toxicon. Sep 15 2003;42(4):339-49. [Medline].
Leathem AM, Dorran TJ. Poisoning due to raw Gyromitra esculenta (false morels) west of the Rockies. CJEM. Mar 2007;9(2):127-30. [Medline].
Michelot D, Toth B. Poisoning by Gyromitra esculenta--a review. J Appl Toxicol. Aug 1991;11(4):235-43. [Medline].
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].
Trestrail JH. Monomethylhydrazine-containing mushrooms. In: Spoerke DG, Rumack BH, eds. Handbook of Mushroom Poisoning: Diagnosis and Treatment. CRC Press LLC; 1994:279-87.
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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