Gyromitra Toxin Toxicity Workup

  • Author: Reed Brozen, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Nov 17, 2011
 

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.
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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.
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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.

Specialty Editor Board

B Zane Horowitz, MD, FACMT  Professor, 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.

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.

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.

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, 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.

References

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