poisoned mushrooms

Question 1

death cap mushrooms mech and toxicity/ target

Answer 1

target: liver, GI, kidney

Toxins: toxic cyclopeptides → amatoxins, phallotoxins, virotoxins
* Dog oral LD50 for methyl-γ-amantin: 0.5 mg/kg BW → extremely toxic**
* ~4 mg amantins per g of mushroom***

• One mushroom can be lethal

-necrosis

Question 2

death cap clinical 4 stages

Answer 2

1. Latency period: 6-12 hrs post-ingestion
   * No clinical signs
   * Detection of a-amantins in urine
2. Gastrointestinal phase: 6-24 hrs post-ingestion → looks like dietary indiscretion/food poisoning
   * Vomiting
   * Bloody diarrhea
   * Abdominal pain

.3 Honeymoon phase: 24-48 hrs post-ingestion, lasting 12-24 hours
* False recovery
* Close monitoring of bloodwork is essential – elevated liver enzymes

4. Terminal phase / “hepatorenal” phase: 36-72 hours post-ingestion
   * Fulminant liver failure: coagulopathy, hepatic encephalopathy
   -renal failure: azotemia
   -death due to acute liver failure

Question 3

death cap management

Answer 3

-early decontamination often missed due to latency

-supportive care + hepatoprotectants
* Octreotide **- inhibits gall bladder contraction + contracts Sphincter of Oddi

diangosis: latency-> liver failure. mushroom in stomach, anatoxins in serum.

Question 4

fly agaricus + panther cap

Answer 4

target: CNS

Toxins: isoxazoles - ibotenic acid, muscimol
* Toxicity: one mushroom can be lethal**

-alternative CNS depression + stimulation

Question 5

fly agaricus + panther cap clinical

Answer 5

Alternating phases of CNS depression + CNS stimulation
* GI: vomiting, diarrhea, abdominal pain, hypersalivation
* CNS: disorientation, lethargy, miosis, hyperesthesia
* Severe intoxications: respiratory failure, bradycardia, seizures, coma

Question 6

fly agaricus + panther cap management

Answer 6

-early decontamination
-sedation
-tremors: methocarbomol
-dont use diazepam for siexers

Question 7

magic mushrooms

Answer 7

• Toxicity: limited toxicity information in animals
• Humans: 6 g considered lethal; 6 mg
  considered threshold for hallucinatory effects
• Death is highly unlikely
• Mechanism: serotonin receptor agonists

Question 8

magic mushroom clinical

Answer 8

• Onset: within 30 minutes to a few hours post-ingestion
• CNS: mydriasis, ataxia, disorientation, vocalization, nystagmus
• High doses: seizures, serotonin syndrome possible,
  -no coma or fatal

-decontaminate, self limiting or supportive care

Question 9

mushroom sampling

Answer 9

• Sampling for identification
• Wrap mushroom in damp paper towel and place in plastic bag
• Retrieve as much of the mushroom as possible (cap, gills, stem, base)
• If possible, note where the mushroom was found (surrounding trees, etc)