Gyromitra Mushroom Toxicity Workup

Updated: Feb 05, 2019
  • Author: Reed Brozen, MD; Chief Editor: Sage W Wiener, MD  more...
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Workup

Laboratory Studies

Electrolytes, BUN, creatinine, and glucose: Patients often are dehydrated. Assess renal function of patients with hemolysis. Hyperglycemia may be present as an acute stress reaction; however, sudden hypoglycemia is a greater concern than hyperglycemia with hepatic injury.

Complete blood count and/or peripheral blood smear: Assess for anemia from hemolysis or blood loss.

Hepatic transaminases and serum bilirubin: Findings may be normal at presentation; however, if hepatic injury exists it becomes abnormal within days of exposure. Bilirubin may be elevated from hemolysis or liver toxicity. Methemoglobin levels: Measure by co-oximetry (determine need for methylene blue treatment).

Tests for hemolysis

The following for hemolysis may be performed:

  • Urinalysis: Positive dip test for blood without RBCs on microscopic analysis suggests either hemolyzed blood (hemoglobinuria) or myoglobin.

  • Free plasma hemoglobin increases with hemolysis.

  • Serum haptoglobin decreases with hemolysis.

  • 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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