12 III. Coprine Toxins Glutamine-derived toxin Inhibits acetaldehyde dehydrogenase Symptom onset within 15-30 min of alcohol ingestion Severe headache, flushing, tachycardia, hyperventilation, palpitations EtOH sensitivity lasts 2-72 hours Supportive treatment, no role for AC
16 V. Psilocybin & psilocin “Magic Mushrooms” Plentiful in North America Structurally similar to serotonin 5HT(2) 30-60 min: ataxia, hyperkinesis, visual hallucinations. may develop anxiety, agitation, tremors, seizures. Resolution in 6-12 hours.
24 B. Gyromitrin Gyromitra species Inhibits GABA by interfering with pyridoxine Europe > North America Onset 5-10 hours Headache, weakness, nausea, vomiting, cramping, delirium, seizures Rarely progresses to coma, hepatorenal failure, or death
25 Treatment Supportive Activated charcoal Benzodiazepines Pyridoxine 70 mg/kg IV for intractable seizures
29 Treatment ã Supportive ã Dialysis ã Kidney Transplant ã Permanent kidney failure 8-50% ã No role for prophylactic dialysis
30 Newcomers to the Tox Scene Amanita smithiana - allenic norleucine; renal failure Tricholoma equestre -unknown toxin; severe rhabdomyolysis
31 Amanita smithiana All 13 cases in Pacific NW Onset 30 min - 12 hrs (early GI toxicity) Nausea, vomiting, anorexia, malaise, dizziness, diaphoresis Acute renal failure 4-6 days later Elevated BUN, Creatinine, ALT
32 No deaths Prolonged dialysis Toxin: allenic norleucine (amino acid) Early onset GI symptoms vs. late (A. smithiana vs. C. rainierensis) Treatment: - Supportive - Activated charcoal - Dialysis
33 Tricholoma equestre 12 patients-all had eaten 3 meals of mushrooms Southwestern France Onset 24-36 hours Fatigue, myalgias, proximal muscle weakness Mean CPK 22,000 women; 34,000 men AST 1200/ALT 600 3 deaths
34 Tricholoma equestre Toxin unknown-acute myopathy on biopsy CK elevation reproduced in mice No US cases
35References Auerbach, P. & Schneider, S. “Mushroom Toxicity” Wilderness Medicine 4th Ed. Mosby 2001; 1141-1160 Bedry, R. et al “Wild mushroom intoxication as a cause of rhabdomyolysis” NEJM 345; Sept 13, 2001; 798-802 Bickel, M. et al “Severe rhabdomyolysis, acute renal failure, and posterior encephalopathy after ‘magic mushroom’ abuse” Euro J Em Med 2005; 12; 306-308 Burton, J. et al “Liver Transplantation in Mushroom Poisoning” J Clin Gastroenterology 2002; 35(3); 276-280 Diaz, J. “Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisoning” Crit Care Med 2005 Vol. 33, No. 2; 419-426 Goldfrank, L.R: Mushrooms in Goldfrank’s Toxicologic Emergencies 8th Ed. Goldfrank, L., Flomenbaum, N. et al. Appleton and Lange. 2006 1564-1576 Marx, J., Hochberger, R., Walls, R. Rosen’s Emergency Medicine 5th Ed Ch. 158 “Plants, Mushrooms, and Herbal Medicines” Mosby 2002; 2203-2205 Vicellio, P. & Shih, R. “Mushroom Poisoning” Emergency Toxicology 2nd Ed. Lippincott-Raven 1998; 1081-1086
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