Approach Considerations
Prehospital care is primarily supportive, with appropriate attention paid to the ABCs (airway, breathing, circulation). Emergency department (ED) care is primarily supportive as well. [36]
The entire poisoning episode usually subsides in 6-8 hours; some symptoms may take up to several days to fully resolve. Benzodiazepines may be used for sedation and treatment of panic attacks, hallucinations, and seizures. Psychiatric consultation and evaluation may be needed for persistent psychotic symptoms. [1]
Supportive Measures
Symptomatic patients may be treated with supportive measures. Consider gastric lavage if ingestion occurred within approximately 1 hour of presentation (though there are no data to support the efficacy of the procedure in this setting)
Consider oral administration of activated charcoal if the patient presents within 1 hour of ingestion [37] ; however, adsorption to activated charcoal has not been demonstrated for these constituents, [38] and there is no evidence that routine administration of multiple doses of activated charcoal is useful. If vomiting becomes prominent (a rare occurrence) or signs of volume depletion are present, intravenous (IV) fluids may be administered.
Agitated patients should be provided with a quiet, nonthreatening environment. Psychiatric care should be given to patients with intentional ingestions and suicidal thinking.
With good supportive care, most patients recover within 6-8 hours and may be discharged from the ED at that time, provided no complicating issues are present and they have a safe environment to which to return.
Pharmacologic Therapy
Most patients with poisoning due to ibotenic acid−containing mushrooms can be treated without medications. If patients are severely agitated, anxiolytics (eg, benzodiazepines) may be needed. For seizures lasting longer than 5 minutes, various anticonvulsants have been used. It should be kept in mind that respiratory depression has been reported when these agents are administered IV. Preparations must therefore be made to support the airway if necessary. [14]
Ipecac syrup should generally be avoided. Central nervous system (CNS) symptoms develop relatively rapidly after ingestion of ibotenic acid−containing mushrooms, and evidence for the effectiveness of ipecac in this setting is lacking.
With A muscaria poisoning, despite the implications of the species name, few muscarinic effects are observed; consequently, anticholinergic drugs such as atropine are rarely, if ever, needed.
Fever in this setting should not be treated with antipyretics; it is probably the result of agitation and increased motor activity.
Prevention
Cautious mushroom hunters eat only 1 type of mushroom and save a sample in a dry paper bag for later identification, if needed. Identification of mushrooms is best left to experts. Prevention is achieved by eating only mushrooms that are commercially cultivated for human consumption. Mushrooms should be regularly removed from sites where children are routinely present.
Consultations
A mycologist should be consulted to assist with mushroom identification. The regional poison control center may be contacted for consultation, referral, and, if necessary, assistance in mushroom identification. A nationwide telephone number, 1-800-222-1222, is available in the United States; calls to this number are automatically directed to the nearest poison control center. A mycologist can also be contacted through a mycology club, the North American Mycological Association (NAMA), a botanical garden, or a local university.
Consultation with a medical toxicologist may be helpful, if available. Consultation with a psychiatrist is advisable when the patient may have had suicidal intent.
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Fly agaric (Amanita muscaria).
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Amanita pantherina.
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Amanita muscaria.
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Amanita muscaria var. guessowii with yellow cap surface, from Massachusetts.
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Amanita muscaria var. formosa sensu Thiers, from Oregon.
