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Gyromitra Mushroom Toxicity Medication

  • Author: Reed Brozen, MD; Chief Editor: Asim Tarabar, MD  more...
 
Updated: Apr 14, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity, prevent complications, and neutralize the effects of the toxin.

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GI decontaminants

Class Summary

Empirically used to minimize systemic adsorption of toxin. May benefit only if administered within 1-2 hours of ingestion.

Activated charcoal (Liqui-Char)

 

Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal adsorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water. For maximum effect, administer within 30 min of ingesting poison.

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Pharmacologic antidotes

Class Summary

Prevents seizure recurrence and terminates clinical and electrical seizure activity. May be used in conjunction with benzodiazepines.

Pyridoxine (Nestrex)

 

Involved in synthesis of GABA within CNS. Administer with benzodiazepines.

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Benzodiazepines

Class Summary

Prevents seizure recurrence and terminates clinical and electrical seizure activity. May be used in conjunction with pyridoxine (vitamin B-6).

Diazepam (Valium)

 

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

Lorazepam (Ativan)

 

Sedative hypnotic with short onset of effects and relatively long half-life. May depress all levels of CNS, including limbic and reticular formation, by increasing action of GABA, which is a major inhibitory neurotransmitter in the brain. Monitoring patient's blood pressure after administering dose is important. Adjust prn.

Midazolam (Versed)

 

Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.

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Methemoglobin treatments

Class Summary

In reduced form, leukomethylene blue is an electron donor to reduce methemoglobin. Reduction of methylene blue is by NADPH generated by G-6-PD.

Methylene blue (Urolene blue)

 

Used to convert ferrous iron of reduced hemoglobin to ferric form that is the basis for antidotal action.

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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, 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 Medical Association, New Hampshire Medical Society, Society of Critical Care Medicine, Undersea and Hyperbaric Medical Society, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

Additional Contributors

B Zane Horowitz, MD, FACMT Professor, Department of Emergency Medicine, Oregon Health and Sciences University School of Medicine; 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 College of Medical Toxicology

Disclosure: Nothing to disclose.

Acknowledgements

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.

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