Orellanine Mushroom Toxicity Treatment & Management

Updated: Aug 21, 2014
  • Author: Reed Brozen, MD; Chief Editor: Asim Tarabar, MD  more...
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Treatment

Prehospital Care

Routinely assess, stabilize acute life-threatening conditions, and initiate appropriate therapy.

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Emergency Department Care

See the list below:

  • Stabilize acute life-threatening conditions with resuscitative measures, including ABCs, coma protocols, and fluid resuscitation.
  • 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.
  • Correct shock and dehydration.
  • Monitor urine output.
  • 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.
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Consultations

See the list below:

  • 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.
  • A toxicology consultation, if available, is useful.
  • Expert assistance from a mycologist may be useful in mushroom identification.
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