Emergency Department Care
Stabilize acute life-threatening conditions with resuscitative measures. Correct shock and dehydration. Monitor urine output.
Since patients often present days after ingestion, there is little value exists for acute gastrointestinal decontamination measures such as activated charcoal or lavage. Activated charcoal might be of benefit in the event of very recent orellanine mushroom ingestion. Contraindications and cautions include delayed presentation, multiple episodes of emesis, and depressed level of consciousness. Consider an antiemetic for ongoing nausea and vomiting.
Seizures occur very rarely but, when present, the drug of choice is a benzodiazepine followed by phenytoin.
Urgent hemodialysis may be necessary for significant renal failure or electrolyte disturbances. Early hemoperfusion or hemodialysis, soon after ingestion and before any evidence of renal injury, has been advocated. Scant data exist on this early intervention and clinical efficacy is uncertain.
Admit all symptomatic patients for further management and observation. Intermittent hemodialysis may be necessary if renal failure is severe. Patient should be in a facility that has nephrology specialists and hemodialysis capability.
Early management of an orellanine exposure without signs of renal injury is undefined. Consider outpatient management only after careful consultation with a toxicologist and/or nephrologist and if close follow-up is possible.
Consultations
Consult nephrology for urgent hemodialysis, if needed, and for ongoing assistance with inpatient management. Consult regional poison control center for assistance in locating a mycologist. Expert assistance from a mycologist may be useful in mushroom identification. A toxicology consultation, if available, is useful.
