Disulfiramlike Mushroom Toxicity Treatment & Management

Updated: Apr 20, 2015
  • Author: C Crawford Mechem, MD, MS, FACEP; Chief Editor: Asim Tarabar, MD  more...
  • Print
Treatment

Prehospital Care

Supportive care and parenteral rehydration are essential.

Next:

Emergency Department Care

Symptomatic treatment (eg, antiemetics) and supportive maneuvers are mainstays of medical management.

  • Provide intravenous fluids if GI effects have not abated.
  • Hypotension generally responds to volume expansion with normal saline.
  • Patients with severe hypotension may require vasopressor agents once volume restoration is ensured. Direct-acting vasopressors (eg, norepinephrine) are preferred over indirect-acting agents (eg, dopamine). Recommendation is an extension of known pharmacology of disulfiram, which inhibits dopamine beta-hydroxylase, thereby depleting presynaptic catecholamines.
  • Activated charcoal may be beneficial if mushrooms were ingested recently.
  • Fomepizole (4-methylpyrazole) could theoretically be of benefit by blocking alcohol dehydrogenase and formation of acetaldehyde. Its use in the treatment of methanol and ethylene glycol poisoning is well established. Fomepizole is currently very expensive, and its use is not established in this clinical setting.
  • Histamine-2 blockers (cimetidine is best studied) reduce the severity of flush and hypotension in Asian patients who experience these effects following ethanol ingestion. The Asian flush is due in part to a relative deficiency of aldehyde dehydrogenase.
  • Antiemetics with alpha-adrenergic blocking properties (eg, aliphatic and piperidine phenothiazines) should be avoided.
Previous
Next:

Consultations

Consultation with a regional Poison Control Center, toxicologist, or mycologist may be helpful.

Previous