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Gyromitra Mushroom Toxicity Treatment & Management

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

Prehospital Care

Initiate supportive care, including intravenous (IV) fluids and seizure control with pyridoxine and benzodiazepines.

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Emergency Department Care

See the list below:

  • Initiate supportive care and decontamination as follows:
    • ABCs and coma protocols
    • Correction of fluid and electrolyte imbalances
    • Antiemetics (if needed)
    • Dextrose (if needed)
    • Consideration of activated charcoal (although with typical delayed presentation of poisoning by Gyromitra species, value from this intervention is unlikely)
  • Administer IV fluids to maintain brisk urine output and prevent renal damage from hemolysis.
  • Treat seizures with both pyridoxine (vitamin B-6) and benzodiazepines.
    • Although limited cases exist in which pyridoxine was used as an antidote for gyromitrin-containing mushroom poisoning, pyridoxine is the antidote of choice for isoniazid-induced seizures, which are due to hydrazine and hydrazone metabolites of isoniazid interfering with GABA synthesis.
    • Phenobarbital has been demonstrated to increase metabolism of hydrazines to toxic metabolites and should be avoided. Phenobarbital metabolism may be decreased if liver failure from gyromitrin toxicity has occurred.
  • Methemoglobinemia involves oxygen and methylene blue.
    • Methemoglobin cannot transport oxygen; functional anemia results.
    • Modest levels of methemoglobinemia may be tolerated with supportive care. With higher levels (eg, >20%) and associated symptoms, such as mental status changes, dyspnea, ischemic chest pain, or acidosis, consider treatment with methylene blue.
  • Anemia due to hemolysis may require blood transfusion.
  • Theoretically, folinic acid may be beneficial. Hydrazines inhibit metabolism of folic acid to tetrahydrofolate.
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Consultations

See the list below:

  • Consultation with a regional poison control center and toxicologist may be helpful. They may assist in contacting a mycologist for mushroom identification.
  • Obtain a gastroenterology consultation if evidence of liver dysfunction is present.
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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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