History
Determining history of mushroom exposure is helpful. Query patients presenting with gastroenteritis about mushroom collecting, cooking, and ingestion.
Onset of symptoms typically is delayed with gyromitrin poisoning. GI symptoms typically occur 6-10 hours after ingestion; however, symptoms may begin earlier with severe poisonings. Symptoms may be delayed 48 hours with mild poisonings. Inhalation exposure characteristically produces symptoms within 2 hours of exposure. GI phase of toxicity may be followed by neurologic and hepatorenal toxicity.
Details of ingestion and progression of symptoms are helpful in differentiating ingestions of different mushroom types. Ask the following questions to ascertain specific history:
-
When were the mushrooms ingested (or when was patient exposed to vapors of cooking mushrooms)?
-
When did each symptom begin?
-
Where were the mushrooms found?
-
Were other species ingested?
-
Did others become ill after eating the mushrooms?
Clinical history includes the following:
-
GI symptoms are prominent, with complaints of abdominal pain, bloating, vomiting, and diarrhea.
-
Other complaints (eg, weakness, dizziness, headache, confusion, seizures) may be caused by volume depletion, anemia, and renal, hepatic, or neurologic toxicity.
-
Typical duration of symptoms is 1-2 days but may be as long as 5 days.
Physical Examination
Vital signs in patients with gyromitra mushroom poisoning may include the following:
-
Tachycardia
-
Hypotension
-
Tachypnea (secondary to methemoglobinemia and/or hemolysis)
-
Fever
General appearance may include the following:
-
Dry skin with poor turgor (from vomiting and fluid losses)
-
Pale skin (from hemolysis)
-
Cyanosis unresponsive to oxygen (from methemoglobinemia)
-
Jaundice (from liver damage and hemolysis)
Neurologic findings may include the following:
-
Tremor, muscle spasms
-
Seizures, delirium
-
Stupor and encephalopathy
Abdominal and rectal findings may include the following:
-
Hyperactive bowel sounds, bloating, mild tenderness to palpation
-
Hepatomegaly
-
Liquid or heme-positive stool
