Mushroom and plant ingestion

Question 1

Discuss risk assessment of mushroom ingestion

Answer 1

-The majority of mushroom poisoning cases in Australia manifest with acute GIT toxicity - a rapid resolution of symtpoms and good outcomes with supportive care

Worldwide cyclopeptide hepatotoxic poisoning particularly from amanita phalloides accounts for the majority of mushroom related deaths

• Almost all occur int the ACT
• Cyclopeptide hepatotoxic poisoning must be considered whenever GIT symptoms develop more than 6 hours after ingestion

Question 2

List clinical syndrome associated with mushroom poisoning and the toxin asscoiated

Answer 2

1) Miscellasnous GIT
- multiple mushrooms but nil specific toxic mechanisms

2) Cholinergic
- SLUDGE
- onset 30minutes - 2 hours
- TOXIN - muscarine

3) hallucinogenic
- ataxia, diarrhoea, lacrimation, salivation, urinary incontenence, bronchorrhoea, bronchospasms miosis
- within minutes
- TOXIN psilocybin

4) Disulfiram like
- nasuea vomiting, tachyradia, facial flashing
- onset after ETOH consumption within 7 days of muschroom ingestion
- TOXIN -coprine

5) Glutaminergic
-Dizzness, drowsiness, delirium, dysphora, halluciantions, hyperreflxia, mycolonus
-30-2houts
TOXIN- muscimol

6) Epileptogienc
-Nausea vomiting diarrhoea, headache, ataxia, fatigue, nystagmus, tremor, vergio
-GI symptoms withihn 4-6 hours , delated hepatoxicity 2-3 days,, delayed haemolyiss and maethaemoglobinaemia 1-3 days after hepatic injury
TOXIN - gyromitirin

7) Hepatotoxic
-Nausea and vomiting, abdo cramps 6-24 hours
-Transient clinical improvement during asymptomatic increase in heaptic transaminases -18-36 hours
-progressive heaptic failure, kidney injurym DIC and progression to MOF 1-7 days
-Recovery in survivors >7 days
TOXIN -three class of cyclopepetie
1) amatoxins
2) phallatoxin
3) virotoxins

Question 3

Discuss management of muschroom ingestion

Answer 3

RESUS
-patients can present with ALOC, seizures, cholinergic or signifiacnt hypovolaemia secondary to git fluid loss.

IX - get a mycologist involved
-hydrocholoric acid applied to mushroom will turn blue if cyclopeptide is present

D:- charcoal if GI delayed beyond 6 hours after ingestion
E: if cyclopeptide possible consideration for MDAC
A: NAC, High dose benzyl penicillin 600mg/kg/dayu, silibinin

Question 4

Discuss important plant toxins

Answer 4

1) Aconite (aconitum, delphinium)
- Found in some asian Herbal medicines
- Binds to voltage dependent sodium channels leading to permanent activation fo cardiac muscle and voltage dependent nervous tissue receptors.
- Dose dependant manifestations
- –CVS bradycardia and hypotension progressing to tachydysrhythmias and cardiac arrest
- –CNS -Respiratory depression, paralysis and siezures
- – GIT nasuea and vomiting

2) Belladonna alkaloids (atropa belladonna, Jimson weed, angels trumpet)
- Anticholinergic poisoning

3) Cardiac glycosides (Foxglove, pink, white or yellow oleander)
- Bradycardia, dysrhytmias, GI disturbance

4) CHolchicine ( autumn crocus, glory lily)
- Gi disturbance , bone marrow depsression, MOG

5) hypoglucine (ackee)
- hypoglycaemia, acidaemia, vomiting, seiures.