SAQ 120 – Toxicology – mushroom poisoning

Question 8. mushroom poisoning.

a. Usual initial symptoms

• Gastrointestinal upset, including diarrhoea and vomiting.

b. Serious versus benign predictor

• Timing of symptom onset: benign ingestions usually cause symptoms within 3 hours, while sinister ingestions often present after more than 6 hours.

c. Most fatal mushroom

• Amanita phalloides, the death cap mushroom.

d. Life-threatening effects

• Liver failure.
• Renal failure.

e. Management steps

• Early and aggressive gastric decontamination.
• Consider emesis if presentation is within 2 hours or if GI symptom onset is delayed more than 6 hours after ingestion.
• Multiple-dose activated charcoal.
• Supportive care.
• Consult a toxinologist in all cases.
• Assess whether others ate the same mushrooms.
• Do not discharge without toxicology advice; monitor for late severe liver failure and acute renal failure.

f. Possible antidotes

• Atropine.
• N-acetylcysteine.
• Penicillin.
• Silibinin.
• Cimetidine.
• Alpha-lipoic acid / thioctic acid.
• Pyridoxine.