Amatoxin Toxicity in Emergency Medicine Clinical Presentation

  • Author: Andrew K Chang, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 6, 2011
 

History

With amatoxin ingestion, onset of GI symptoms typically is delayed 6-12 hours or more. An earlier onset of symptoms suggests that another mushroom is responsible for symptomatology. However, if the patient's meal included several different mushrooms, an earlier onset of symptomatology does not rule out concomitant amatoxin ingestion.

  • Presenting complaints include severe abdominal pain, cramping, nausea and vomiting, profuse diarrhea, and weakness.
  • With delayed presentation, complaints may include symptoms attributable to hepatic dysfunction, such as jaundice, lethargy, or bruising.
  • If a mushroom sample is available, place it in a dry paper bag (do not moisten or refrigerate).
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Physical

Assessing the patient's volume status is an important component of the initial evaluation. With delayed presentations, look for signs of hepatic or CNS dysfunction.

  • Vital signs
    • Tachycardia
    • Hypotension
  • Skin
    • Poor turgor
    • Jaundice, bruising (with hepatic failure)
  • Abdomen
    • Mild tenderness
    • Diarrhea, may have a positive result on a Hemoccult test (guaiac positive)
  • Neurologic (if hepatic failure or hypoglycemia)
    • Confusion
    • Lethargy
    • Coma
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Causes

  • Unintentional childhood ingestions
  • Misidentification of mushroom by forager
  • Deliberate seeking of psychotropic mushrooms
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Contributor Information and Disclosures
Author

Andrew K Chang, MD  Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Glenn Bowman, MD, MS  Consulting Staff, Highfield MRI, Columbus, Ohio

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & 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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  2. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). Dec 2008;46(10):927-1057. [Medline]. [Full Text].

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  16. Warden CR, Benjamin DR. Acute renal failure associated with suspected Amanita smithiana mushroom ingestions: a case series. Acad Emerg Med. Aug 1998;5(8):808-12. [Medline].

  17. Yamada EG, Mohle-Boetani J, Olson KR, Werner SB. Mushroom poisoning due to amatoxin. Northern California, Winter 1996-1997. West J Med. Dec 1998;169(6):380-4. [Medline].

 
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