 Amanita phalloides (death cap)  A. verna  A.virosa  Galerina marginata

 1-Amatoxins › Α-amanitin › β-amanitin  2-Phallotoxin › Phalloidin

Amatoxin: high oral absorb, entrohepatic circulation, renal reabsorption Phallotoxin: very low oral absorption (no oral toxicity) Both : heat stable

 Inhibit RNA polymerase ║  Interfere DNA Transcription Protein Synthesis Necrosis

 Liver  KIDNEY  PANCREAS  INTESTINE

 Bind to actin  Disrupt cell membrane liver  protein synthesis

 1-- GI effect (6-24h) › Abdominal pain › nausea › vomiting › Diarrhea › Fever › Hypoglycemia › elecrolyte imbalance

 2- Temporary clinical remission (24-72h)  Toxin induce cell injury (misdiagnose)

 3--Hepatorenal phase (3-6 days) › Hepatic-renal failure › Pancreatitis › Coagulophaty › Seizure › Coma

 Lavage  Charcoal  Diuresis  Electrolyte balance  Vit K  FFP  Glucose

 300,000-One million IU/Kg (seizure)  Displace toxin from protein binding renal excretion

 140 mg TID  Inhibit toxin uptake by cells  NAC– thioctic acid– hyperbaric(oxygen) regenerate  Hemodialysis- hemopefusion late

 Gyromitra esculenta gyromitrin GI methyl formyl hydrazine GI Methyl Hydrazine

 Inhibit Pyridoxal Phosphate GABA seizure  liver Nitrosamide Liver Toxicity  Inhibit histaminase His GI effect  Inhibit Dihydrofolate Reductase Anemia  Induce oxidative Stress Hemolysis, Methemoglobinemia

 GI: nausea-vomit-abdo pain-diarrhea  CNS: dizziness-headache- seizure -coma  Liver: ALT and AST-coagulopathy- jaundice  Blood: hemolysis-metHb-anemia-  others: hypotension-rhabdomyolysis

 metHb > 30% ---- methylene blue + o2 supp  Folinic acid : 5-15 mg/day for 7 day  Pyridoxine: up to 25 mg/kg +diazepam seizure  Vit K – fluid (ringer-lactat) alkaline urine prevent myoglobin deposition

 Heat stable  Low oral absorbtion  Clitocybe  Inocybe  No effect on nicotinic receptor  No CNS effect

 Cholinergic: › salivation › lacrimation › Diarrhea › Bradycardia › Hypotension › perspiration

 Lavage  Charcoal  Ipratropium (inhalation)  Atropine  Glycopyrolate (0.5 to 1 mg ) IV No CNS effect

AMANITA MUSCARIA AND AMANITA PANTHERINA

 Ibotenic acid NMDA activation excitation  muscimol GABA agonist depression  serotonin, dopamine

 Ephoria depression  Agitation somnolence  Amnestic to event during intoxication  GI effect – tremor –ataxia – hallucination-salivation-perspiration- bradycardia  no effect on muscarinic receptors

 Charcoal  Quiet, dark room  Diazepam in agitation  No role for atropine  Poison exctract by water (discard water)

Psilocybin (heat stable) psilocin

 Psilocybe  Gymnopilus  panaeolus

Stimulate (5HT 2 A) receptor LSD like effect

 Mydriasis  Blurred vision  Hypotension  Tachycardia  Euphoria  Agitation  Hallucination  Hyperthermia  seizure

 Charcoal  Quiet and dark room  Diazepam  Antipsychotic worsen hyperthermia Or induce seizure)

CHLOROPHYLLUM MOLYBDITES OMPHALOTUS OLEARIUS

 Toxin not isolated  Cooking decrease toxicity

 Nausea  Vomiting  Abdominal pain  Bloody diarrhea  Bradycardia  Diaphoresis  Chills  dizziness

GI effect + muscarinic like effect without salivation and lacrimation

 Fluid  Electrolyte  Ondansetron  Charcoal (low effect)

CORTINARIUS GENTILIS SPECIO SISSIMUS ORELLANUS AMANITA SMITHIANA

 Cortinarius:  Orellanine (heat stable) Disruption of actin and inhibit protein synthesis  Cortinarin A, cortinarin B  A.smithiana :  Aminohexadienoic acid

 36h post ingestion! Nausea – vomiting – headache – polydipsia  7-10 day : renal failure (tubulin necrosis) oliguria - anuria

 Hemodialysis for a long time is a supportive care ( % improve after several weeks)

 COPRINUS ATRAMENTARIOUS  COPRINE (HEAT STABLE) AMINOCYCLOPROPANOL

 INHIBIT ALDEHYDE DEHYDROGENASE If ethanol ingestion within 48 h after mushroom Flushing-vomiting-tachycardia-arrhythmia

 Hemodialysis ethanol acetaldehyde  Fomepizole: inhibit alcohol dehydrogenase

RUSSULA SUBNIGRICANS TRICHOLOMA EQUESTER

 GI effect + myalgia (myoglobinuria)  Treatment:  Fluid, alkaline urine