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Laboratory Studies
Patients with gyromitra mushroom poisoning may have muddy-colored urine from hemoglobinuria (due to hemolysis) and brown-colored blood (from methemoglobinemia). Blood test results in patients with gyromitra mushroom toxicity include the following:
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Metabolic panel: Patients often are dehydrated. Patients with hemolysis may have impaired kidney function. Hyperglycemia may be present as an acute stress reaction; however, sudden hypoglycemia is a greater concern than hyperglycemia with hepatic injury.
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Complete blood count and/or peripheral blood smear: Assess for anemia from hemolysis or blood loss.
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Hepatic transaminases and serum bilirubin: Levels may be normal at presentation; however, if hepatic injury exists, liver function study results becomes abnormal within days of exposure. Bilirubin may be elevated from hemolysis or liver toxicity.
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Methemoglobin levels: Measure by co-oximetry (determine need for methylene blue treatment).
Tests for hemolysis
The following for hemolysis may be performed:
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Urinalysis: Positive dip test for blood without red blood cells on microscopic analysis suggests either hemolyzed blood (hemoglobinuria) or myoglobin.
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Free plasma hemoglobin: Level increases with hemolysis
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Serum haptoglobin: Level decreases with hemolysis
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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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