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Toxicity, Mushroom - Gyromitra Toxin: Follow-up

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

Follow-up

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

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider diagnosis
  • Failure to elicit history
  • Assuming that everyone who ingests mushrooms becomes ill or suffers same severity of illness
  • Discharging asymptomatic patients prematurely or without good follow-up instructions and planned follow-up care
  • Failure to consider ingestion of several species of mushrooms, including more toxic species (eg, Amanita phalloides), when patient presents within hours of mushroom ingestion
 


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

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  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].

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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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