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MUSHROOMS-GASTROINTESTINAL

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Gastrointestinal mushrooms are commonly referred to as POISINDEX(R) Group 7 mushrooms.

Specific Substances

    A) AGARICUS SPECIES
    1) Agaricus hondensis - "Felt-ringed Mushroom"
    2) Agaricus placomyces - "Flat-top Mushroom"
    3) Agaricus silvaticus - "Woods Psalliota"
    4) Agaricus sylvicola - "Wood-loving Mushroom"
    5) Agaricus xanthodermis
    6) Felt-ringed Mushroom - "Common name for Agaricus hondensis"
    7) Flat-top Mushroom - "Common name for Agaricus placomyces"
    8) Woods Psalliota - "Common name for Agaricus silvaticus"
    9) Wood-loving Mushroom - "Common name for Agaricus sylvicola"
    BOLETUS SPECIES
    1) Boletus calopus (bitter)
    2) Boletus eastwoodiae - Boletus pulcherrimus
    3) Boletus eastwoodii
    4) Boletus erythropus - "Red-footed Bolete"
    5) Boletus luridus - "Lurid Boletus"
    6) Boletus miniato-olivaceus
    7) Boletus pulcherrimus - "Red-pored Bolete"
    8) Boletus satanus - "Satan's Bolete"
    9) Boletus sensibilis - "Sensitive Boletus"
    10) Leccinum aurantiacum - "Orange cap"
    11) Leccinum insigne - "Orange cap"
    12) Leccinum spp
    13) Lurid Boletus - "Common name for Boletus luridus"
    14) Red-footed Bolete - "Common name for Boletus erythropus"
    15) Red-pored Bolete - "Common name for Boletus pulcherrimus"
    16) Satan's Bolete - "Common name for Boletus satanus"
    17) Sensitive Boletus - "Common name for Boletus sensibilis"
    18) Suillus americanus (also may cause contact dermatitis)
    19) Suillus granulatus (also may cause contact dermatitis)
    20) Suillus luteus - (also may cause hemolytic crisis)
    21) Suillus tomentosus - (also may cause contact dermatitis)
    CHLOROPHYLUM SPECIES
    1) Chlorophyllum esculentum - Chlorophyllum molybdites
    2) Chlorophylum molybdites
    3) False Parasol
    4) Green gilled lepiota
    5) Green-Lined Parasol
    6) Green parasol
    7) Green-spored Lepiota
    8) Lepiota esculenta - Volvariella esculenta
    9) Lepiota morganii
    10) Lepiota molybdites
    11) Lepiota naucina
    12) Morgan's Lepiota
    13) Morgan's Mushroom
    14) Smooth Lepiota
    CLITOCYBE SPECIES
    1) Clitocybe illudens - "Jack-o-Lantern"
    2) Clitocybe olearius
    3) Clitocybe nebularis - "Gray cap"
    4) Omphalotus olearius
    5) Jack-o-Lantern - "Common name for Clitocybe illudens"
    6) Gray cap - "Common name for Clitocybe nebularis"
    ENTOLOMA SPECIES
    1) Entoloma grande
    2) Entoloma lividum (E sinuatum)
    3) Entoloma salmoneum
    4) Entoloma murraii
    5) Entoloma strictius
    HEBELOMA SPECIES
    1) Hebeloma crustuliniforme - "Poison Pie"
    2) Hebeloma mesophaeum
    3) Hebeloma sinapizans - "Giant Hebeloma"
    4) Giant Hebeloma - "Common name for Hebeloma sinapizans"
    5) Poison Pie - "Common name for Hebeloma crustuliniforme"
    LACTARIUS SPECIES
    1) Lactarius chrysorheus - "Yellow-juiced Lactarius"
    2) Lactarius deceptivus - "Deceptive Lactarius"
    3) Lactarius glaucescens
    4) Lactarius piperatus - "Pepper Cap"
    5) Lactarius repraesentaneus
    6) Lactarius rufus - "Red Milky Cap"
    7) Lactarius scrobiculatus - "Spotted-stemmed Lactarius"
    8) Lactarius subvellereus
    9) Lactarius torminosus - "Woolly Milky Cap"
    10) Lactarius tomentosus
    11) Lactarius uvidus - "Grape-colored Lactarius"
    12) Lactarius vellereus - "Fleecy Milky Cap"
    13) Deceptive Lactarius - "Common name for Lactarius deceptivus"
    14) Grape-colored Lactarius - "Common name for Lactarius uvidus"
    15) Fleecy Milky Cap - "Common name for Lactarius vellereus"
    16) Pepper Cap - "Common name for Lactarius piperatus"
    17) Red Milky Cap - "Common name for Lactarius rufus"
    18) Spotted-stemmed Lactarius - "Common name for Lactarius scrobiculatus"
    19) Woolly Milky Cap - "Common name for Lactarius torminosus"
    20) Yellow-juiced Lactarius - "Common name for Lactarius chrysorheus"
    RUSSULA SPECIES
    1) Russula densifolia
    2) Russula emetica
    3) Russula fragilis
    TRICHOLOMA SPECIES
    1) Tricholoma pardinum
    2) Tricholoma venenatum
    3) Tricholoma pessundatum
    OTHER MISC. SPECIES
    1) Armillaria mellea - "Stumper", "Honey Mushroom"
    2) Collybia drophila - "Nut-brown Collybia"
    3) Gomphus floccosus - "Wooly Chanterelle"
    4) Leucoagaricus putidus
    5) Marasimus urens
    6) Naematoloma fasciculare
    7) Omphalotus guepiniformis
    8) Pholiota squarrosa
    9) Ramaria formosa
    10) Scleroderma citrinum (aurantium)
    11) Elfin Saddle - "Common name for Helvella lacunosa"
    12) Honey Mushroom - "Common name for Armillaria mellea"
    13) Nut-brown Collybia - "Common name for Collybia dryphila"
    14) Stumper - "Common name for Armillaria mellea"
    15) Wooly Chanterelle - "Common name for Gomphus floccosus"

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: These mushrooms are ingested by foragers who mistake them for edible mushrooms, and by children exploring their environment. A wide variety of mushrooms can cause gastrointestinal irritation. Species of the genera Agaricus, Boletus, Chlorophyllum, Clitocybe, Entoloma, Hebeloma, Lactarius, Russula, and Tricholoma are among the most common.
    B) TOXICOLOGY: Most toxins in this group are still unknown and therefore most mechanisms of action are also unknown. Some toxins have been isolated. Gomphus Species: The toxin is believed to be nocaperatic acid, which is structurally similar to citric acid and inhibits the enzyme aconitase. Laccaria amethystine is known to contain lectins, which are hemoagglutinins and also likely to be gastrointestinal irritants. Many reactions are idiosyncratic, and allergic reactions have been proposed as a possible mechanism.
    C) EPIDEMIOLOGY: Exposure is common, and these mushrooms (especially Chlorophyllum species) are the most common cause of symptomatic mushroom poisoning in the United States. Severe toxicity is rare and no recent fatalities have been reported.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: These mushrooms are characterized by nausea and vomiting with onset within 2 to 4 hours of ingestion; symptoms generally improve in 3 to 4 hours with complete resolution within a day or two. Diarrhea may develop in a more delayed fashion (8 to 12 hours). Other symptoms may include abdominal cramps, alterations in taste sensation, malaise, headache, pallor, and occasionally circumoral and hand paresthesias from anxiety and hyperventilation.
    2) SEVERE TOXICITY: Severe toxicity is rare but can include severe persistent vomiting, profuse diarrhea, abdominal pain, hemorrhagic enteritis, dehydration, electrolyte abnormalities, pallor, weakness, diaphoresis, and hypotension. One case of hemorrhagic enteritis has been reported 30 hours after eating Tsukiyotake (Omphalotus guepiniformis).

Laboratory Monitoring

    A) No specific laboratory evaluation is required in patients with self-limited symptoms.
    B) Monitor serum electrolytes in patients with severe vomiting and/or diarrhea.
    C) Monitor CBC in patients with hemorrhagic enteritis.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    1) Oral or intravenous rehydration and antiemetics as needed.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) Intravenous rehydration and administration of antiemetics. In general, hypotension should respond to fluid, but persistent hypotension can be treated with vasopressors.
    C) DECONTAMINATION
    1) There is no role for decontamination in these cases.
    D) AIRWAY MANAGEMENT
    1) Should not be required in these cases.
    E) ENHANCED ELIMINATION PROCEDURE
    1) Not indicated.
    F) PATIENT DISPOSITION
    1) HOME CRITERIA: If the onset of gastrointestinal symptoms is within 6 hours of ingestion and only one kind of mushroom has been ingested, or if the ingested mushrooms have been identified and are known to not be hepatotoxic or nephrotoxic, patients with mild symptoms can be monitored at home.
    2) OBSERVATION CRITERIA: Patients with more than self-limited symptoms should be referred to a medical facility for evaluation or treatment. If the onset of vomiting was more than 6 hours after ingestion, or if more than one type of mushroom has been ingested and they cannot all be identified as not hepatotoxic or nephrotoxic, the patient should be referred to a healthcare facility for evaluation and treatment.
    3) ADMISSION CRITERIA: Patients should be admitted for severe vomiting, profuse diarrhea, severe abdominal pain, hemorrhagic enteritis, dehydration, and electrolyte abnormalities.
    4) CONSULT CRITERIA: Consult a mycologist (through your local poison center) for identification of the ingested mushroom and a medical toxicologist for assistance with medical management.
    G) PITFALLS
    1) Patients ingesting these mushrooms develop nausea and vomiting within 2 to 4 hours of ingestion. If nausea and vomiting develop 6 hours or later after ingestion, it raises the concern for the ingestion of more toxic genera such as cyclopeptide or gyromitrin mushrooms. If more than one type of mushroom is ingested, there is the possibility of coingestion of more toxic species.
    H) PHARMACOKINETICS
    1) ONSET: Onset is variable but typically within 30 minutes to 2 hours. DURATION OF ACTION: 3 hours to 2 days.
    I) DIFFERENTIAL DIAGNOSIS
    1) Acute gastroenteritis, food poisoning, pancreatitis, cholecystitis, infectious etiologies, cardiovascular etiologies.

Range Of Toxicity

    A) TOXICITY: There are no recent reports of fatalities. In a given group of people, all eating the same mushroom, some will be ill and others remain symptom free. The same mushroom may be eaten by an individual on one occasion without ill effects and produce severe symptoms when ingested the next time. There is not always a correlation between the quantity ingested and clinical effects.

Clinical Effects

Summary Of Exposure

    A) USES: These mushrooms are ingested by foragers who mistake them for edible mushrooms, and by children exploring their environment. A wide variety of mushrooms can cause gastrointestinal irritation. Species of the genera Agaricus, Boletus, Chlorophyllum, Clitocybe, Entoloma, Hebeloma, Lactarius, Russula, and Tricholoma are among the most common.
    B) TOXICOLOGY: Most toxins in this group are still unknown and therefore most mechanisms of action are also unknown. Some toxins have been isolated. Gomphus Species: The toxin is believed to be nocaperatic acid, which is structurally similar to citric acid and inhibits the enzyme aconitase. Laccaria amethystine is known to contain lectins, which are hemoagglutinins and also likely to be gastrointestinal irritants. Many reactions are idiosyncratic, and allergic reactions have been proposed as a possible mechanism.
    C) EPIDEMIOLOGY: Exposure is common, and these mushrooms (especially Chlorophyllum species) are the most common cause of symptomatic mushroom poisoning in the United States. Severe toxicity is rare and no recent fatalities have been reported.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: These mushrooms are characterized by nausea and vomiting with onset within 2 to 4 hours of ingestion; symptoms generally improve in 3 to 4 hours with complete resolution within a day or two. Diarrhea may develop in a more delayed fashion (8 to 12 hours). Other symptoms may include abdominal cramps, alterations in taste sensation, malaise, headache, pallor, and occasionally circumoral and hand paresthesias from anxiety and hyperventilation.
    2) SEVERE TOXICITY: Severe toxicity is rare but can include severe persistent vomiting, profuse diarrhea, abdominal pain, hemorrhagic enteritis, dehydration, electrolyte abnormalities, pallor, weakness, diaphoresis, and hypotension. One case of hemorrhagic enteritis has been reported 30 hours after eating Tsukiyotake (Omphalotus guepiniformis).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) PARESTHESIA
    1) WITH POISONING/EXPOSURE
    a) Paresthesias are described but often may be attributed to fear and hyperventilation (Smith, 1980; Stevenson & Benjamin, 1973).
    B) TETANY
    1) WITH POISONING/EXPOSURE
    a) Tetany is described but often may be attributed to fear and hyperventilation (Smith, 1980; Stevenson & Benjamin, 1973).
    C) HEADACHE
    1) WITH POISONING/EXPOSURE
    a) Headache has been reported after Entoloma lividum ingestions (Pilat, 1951).
    b) OMPHALOTUS OLEARIUS: Headache, weakness and dizziness have been reported (Spoerke & Rumack, 1994; Maretic et al, 1975).
    D) ASTHENIA
    1) WITH POISONING/EXPOSURE
    a) OMPHALOTUS OLEARIUS: Headache, weakness and dizziness have been reported (Spoerke & Rumack, 1994; Maretic et al, 1975).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) GASTROENTERITIS
    1) WITH POISONING/EXPOSURE
    a) Acute gastroenteritis with nausea, vomiting, and abdominal cramps may be commonly seen (Smith, 1980).
    b) BOLETUS SENSIBILIS: Ingestion of Boletus sensibilis caused severe nausea, vomiting, diarrhea, exhaustion, miosis, and chills (Krieger, 1967).
    c) ENTOLOMA LIVIDUM: Even if ingested in small quantities, this mushroom may cause (within 30 minutes to 2 hours) nausea, vomiting diarrhea, and abdominal pain (Pilat, 1951).
    d) LEUCOAGARICUS PUTIDUS: Several patients experienced abdominal cramp, vomiting, and watery diarrhea approximately 2 hours after ingesting leucoagaricus putidus mushrooms. All patients recovered and were discharged 3 days later (Lee et al, 1996).
    e) OMPHALOTUS OLEARIUS: In a series of patients who ingested an average of 2 mushrooms each, the onset of vomiting was 60 to 150 minutes (Maretic et al, 1975).
    1) Severe gastroenteritis (nausea, vomiting, diarrhea, abdominal cramps) after a latent period of 1 to 3 hours has been reported. In addition, patients have experienced weakness, dizziness, and headache. Although symptoms may be due to a muscarine-like reaction, no muscarine has been identified. Twenty-five cases of ingestion of omphalotus olearius mushrooms (average, 2 mushrooms per person) were reported by Maretic et al (1975); 23 (92%) had symptoms. The severity of poisoning was related to the amount eaten. Symptoms were nausea, vomiting, headache, sweating, a bitter or metallic taste, and both increased and decreased salivation (Spoerke & Rumack, 1994; Maretic et al, 1975).
    f) PHOLIOTA SQUARROSA: has purportedly produced vomiting and diarrhea. Alcohol was ingested with these mushrooms and a disulfiram-like action was proposed, but this was NOT substantiated. The alcohol most likely enhanced the gastroenteritis (Schaffer, 1965).
    g) SCLERODERMA SPECIES: Ingestion may cause abdominal pain, nausea, vomiting, and generalized weakness within 30 minutes. Within 45 minutes there may be cramps, sweating, pallor, and excessive perspiration (Stevenson & Benjamin, 1973).
    h) TRICHOLOMA PARDINUM: Ingestion causes vomiting and diarrhea (as well as headaches) with onset being in 1 to 2 hours and duration being up to 6 hours (Pilat, 1961).
    B) TASTE SENSE ALTERED
    1) WITH POISONING/EXPOSURE
    a) The Lactarius genus contains various sesquiterpenoids (Sterner et al, 1989). Several of the species which are considered to be NOT edible have a pungent taste caused by unsaturated dialdehyde sesquiterpenes with marasmane and lactarane skeletons (Anke et al, 1989).
    C) DIARRHEA
    1) WITH POISONING/EXPOSURE
    a) Gomphus bonari, G. floccosus, and G. kauffmanii: These species are known to produce a delayed onset diarrhea (8 to 14 hours) in both man and animals (1:339-384).
    b) TREHALOSE MALABSORPTION - The disaccharide trehalose is found in young mushrooms, usually in concentrations under 1.4%. Some individuals may have trehalose malabsorption syndrome, which would result in abdominal pain and diarrhea from ingestion of trehalose-containing mushrooms. Such a case was presented by Bergoz (1971) involving Psalliota campestris (Bergoz, 1971).
    D) HEMORRHAGIC ENTERITIS
    1) WITH POISONING/EXPOSURE
    a) OMPHALOTUS GUEPINIFORMIS: A 60-year-old man presented with severe upper abdominal pain approximately 30 hours after eating Tsukiyotake (Omphalotus guepiniformis), a mushroom that contains illudin and resembles Shiitake (Lentinula edodes). An endoscopic examination revealed multiple erosions with oozing blood around the duodenal lumen. The biopsy samples showed a sprouting of inflammatory cells, blood cells, and fibrins on the surface of the duodenal mucosa. Following supportive therapy, he recovered and was discharged 7 days after presentation. Several people who also ate the same mushrooms experienced abdominal pain (Hori et al, 2008).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) PALE COMPLEXION
    1) WITH POISONING/EXPOSURE
    a) Pallor has been noted after ingestion (Stevenson & Benjamin, 1973).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) No specific laboratory evaluation is required in patients with self-limited symptoms.
    B) Monitor serum electrolytes in patients with severe vomiting and/or diarrhea.
    C) Monitor CBC in patients with hemorrhagic enteritis.
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) Careful monitoring of liver and renal parameters will give early warning of serious poisoning.
    B) OTHER
    1) It is most important to identify the mushroom involved since this is the most reliable way to determine the potential dangers.
    2) SPORE IDENTIFICATION: If a mycologist is available, stomach contents should be saved for spore identification. This may aid in identifying the offending mushroom and may suggest other mushrooms that may have been ingested concurrently (Smith, 1980).

Methods

    A) OTHER
    1) A test for yellow staining in Agaricus species (possible gastrointestinal irritant species) is to place one drop of KOH or another alkaline solution (1 teaspoon of Drano(R) crystals dissolved in 0.25 cup of water) on the stem, cap, etc to get rapid yellow staining (Per Comm, 1989).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Patients should be admitted for severe vomiting, profuse diarrhea, severe abdominal pain, hemorrhagic enteritis, dehydration, and electrolyte abnormalities.
    6.3.1.2) HOME CRITERIA/ORAL
    A) If the onset of gastrointestinal symptoms is within 6 hours of ingestion and only one kind of mushroom has been ingested, or if the ingested mushrooms have been identified and are known to not be hepatotoxic or nephrotoxic, patients with mild symptoms can be monitored at home.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Consult a mycologist (through your local poison center) for identification of the ingested mushroom and a medical toxicologist for assistance with medical management.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients with more than self-limited symptoms should be referred to a medical facility for evaluation or treatment. If the onset of vomiting was more than 6 hours after ingestion, or if more than one type of mushroom has been ingested and they cannot all be identified as not hepatotoxic or nephrotoxic, the patient should be referred to a healthcare facility for evaluation and treatment.

Monitoring

    A) No specific laboratory evaluation is required in patients with self-limited symptoms.
    B) Monitor serum electrolytes in patients with severe vomiting and/or diarrhea.
    C) Monitor CBC in patients with hemorrhagic enteritis.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) There is no role for decontamination in these cases.
    6.5.2) PREVENTION OF ABSORPTION
    A) There is no role for decontamination in these cases.
    6.5.3) TREATMENT
    A) MONITORING OF PATIENT
    1) No specific laboratory evaluation is required in patients with self-limited symptoms.
    2) Monitor serum electrolytes in patients with severe vomiting and/or diarrhea.
    3) Monitor CBC in patients with hemorrhagic enteritis.
    B) FLUID/ELECTROLYTE BALANCE REGULATION
    1) Maintenance of fluid and electrolyte balance is especially important in infants, elderly and debilitated patients. Intravenous fluid replacement may be necessary (Levitan et al, 1981).
    C) HYPOTENSIVE EPISODE
    1) SUMMARY
    a) Infuse 10 to 20 milliliters/kilogram of isotonic fluid and keep the patient supine. If hypotension persists, administer dopamine or norepinephrine. Consider central venous pressure monitoring to guide further fluid therapy.
    2) DOPAMINE
    a) DOSE: Begin at 5 micrograms per kilogram per minute progressing in 5 micrograms per kilogram per minute increments as needed (Prod Info dopamine hcl, 5% dextrose IV injection, 2004). If hypotension persists, dopamine may need to be discontinued and a more potent vasoconstrictor (eg, norepinephrine) should be considered (Prod Info dopamine hcl, 5% dextrose IV injection, 2004).
    b) CAUTION: If ventricular dysrhythmias occur, decrease rate of administration (Prod Info dopamine hcl, 5% dextrose IV injection, 2004). Extravasation may cause local tissue necrosis, administration through a central venous catheter is preferred (Prod Info dopamine hcl, 5% dextrose IV injection, 2004).
    3) NOREPINEPHRINE
    a) PREPARATION: 4 milligrams (1 amp) added to 1000 milliliters of diluent provides a concentration of 4 micrograms/milliliter of norepinephrine base. Norepinephrine bitartrate should be mixed in dextrose solutions (dextrose 5% in water, dextrose 5% in saline) since dextrose-containing solutions protect against excessive oxidation and subsequent potency loss. Administration in saline alone is not recommended (Prod Info norepinephrine bitartrate injection, 2005).
    b) DOSE
    1) ADULT: Dose range: 0.1 to 0.5 microgram/kilogram/minute (eg, 70 kg adult 7 to 35 mcg/min); titrate to maintain adequate blood pressure (Peberdy et al, 2010).
    2) CHILD: Dose range: 0.1 to 2 micrograms/kilogram/minute; titrate to maintain adequate blood pressure (Kleinman et al, 2010).
    3) CAUTION: Extravasation may cause local tissue ischemia, administration by central venous catheter is advised (Peberdy et al, 2010).
    D) CONTRAINDICATED TREATMENT
    1) Avoid all but indicated drugs for fear of adverse interaction with unknown toxins.

Enhanced Elimination

    A) SUMMARY
    1) Not indicated.

Abstracts

Case Reports

    A) OTHER
    1) MUSHROOM POISON CASE REGISTRY
    a) MUSHROOM POISON CASE REGISTRY
    1) Mushroom poisoning cases may be reported to the North American Mycological Association's Mushroom Poisoning Case Registry. Reporting is voluntary and patient confidentiality is maintained.
    2) Forms may be obtained from the website and completed forms or questions may be sent to:
    3) Dr. Michael W. Beug, PO Box 116, Husum, WA 98623; phone: (509) 493-2237
    4) Alternatively, reports may be submitted online at www.sph.umich.edu/~kwcee/mpcr. The website also contains a list of volunteers from different regions of North America willing to assist in the identification of mushrooms.
    2) To obtain a mushroom reporting form type "mushroom form" on product entry screen.

Range Of Toxicity

Summary

    A) TOXICITY: There are no recent reports of fatalities. In a given group of people, all eating the same mushroom, some will be ill and others remain symptom free. The same mushroom may be eaten by an individual on one occasion without ill effects and produce severe symptoms when ingested the next time. There is not always a correlation between the quantity ingested and clinical effects.

Maximum Tolerated Exposure

    A) Extremely variable from individual to individual and from mushroom to mushroom. A few fatalities have been reported, mostly from Europe.
    B) In a given group of people, all eating the same mushroom, some will be violently ill and some will remain symptom free. Likewise, the same mushroom may be eaten by an individual on one occasion without ill effects and severe symptoms can develop the next time (Blayney et al, 1980).
    C) Some mushrooms produce symptoms only when consumed with alcohol, yet do NOT give alcohol-antabuse-like symptoms (Groves, 1964). Whether the alcohol enhances absorption of the toxin or acts only as an added irritant is unknown.
    D) The effects of mushroom age, freezing, decay, or strain variation are still unknown.

Pharmacology Toxicology

Toxicologic Mechanism

    A) Many toxins, mostly unidentified.
    B) Some toxins have been isolated and preliminary studies have been done. Norcaperatic acid from Gomphus floccosus and sesquiterpenes from various species of Lactarius have been isolated and partially purified.
    C) Most of the toxins in this group are still unknown. These cannot be identified until reliable data can be gathered on the suspect species and the symptoms produced.
    D) Gomphus species: The toxin is believed to be norcaperatic acid which is structurally similar to citric acid and inhibits the enzyme aconitase (Miyata, 1966). Norcaperatic acid has been shown in animal studies to produce mydriasis, skeletal muscle weakness, and CNS depression (Carrano & Malone, 1967).
    E) Laccaria amethystina is known to contain lectins which are hemoagglutinins (Guillot et al, 1983). These substances are also likely to be gastrointestinal irritants.

Animal Toxicology

Clinical Effects

    11.1.10) PORCINE/SWINE
    A) SCLERODERMA CITRINUM (Galey et al, 1990)
    1) A 7-month-old pig ate a mushroom which was identified as Scleroderma citrinum. Twenty minutes after ingestion the pig vomited and collapsed.
    a) One hour postingestion the pig was depressed, weak, recumbent and still vomiting. Pupillary responses were absent, the animal was hypothermic, tachycardic, and tachypneic. The abdomen was splinted on palpation.
    2) The animal was treated with 20 mg of dexamethasone and 500 mL of 5% dextrose subcutaneously. It died at home 5 hours later.
    11.1.12) RODENT
    A) GUINEA PIG -
    1) Omphalotus olearius: Fatty degeneration of the liver, kidneys, and myocardium was seen when guinea pigs were given this mushroom. Other symptoms included cerebral edema, anemia, and enlargement of the adrenal cortex with degeneration of the spongiocytes (Maretic, 1967).

Treatment

    11.2.1) SUMMARY
    A) GENERAL TREATMENT
    1) SUMMARY
    a) Begin treatment immediately.
    b) Keep animal warm and do not handle unnecessarily.
    c) Remove the patient and other animals from the source of contamination or remove dietary sources.
    2) Treatment should always be done on the advice and with the consultation of a veterinarian.
    3) Additional information regarding treatment of poisoned animals may be obtained from a Veterinary Toxicologist or the National Animal Poison Control Center.
    4) ASPCA ANIMAL POISON CONTROL CENTER
    a) ASPCA Animal Poison Control Center, 1717 S Philo Road, Suite 36 Urbana, IL 61802
    b) It is an emergency telephone service which provides toxicology information to veterinarians, animal owners, universities, extension personnel and poison center staff for a fee. A veterinary toxicologist is available for consultation.
    c) Contact information: (888) 426-4435 (hotline) or www.aspca.org (A fee may apply. Please inquire with the poison center). The agency will make follow-up calls as needed in critical cases at no extra charge.
    11.2.2) LIFE SUPPORT
    A) GENERAL
    1) MAINTAIN VITAL FUNCTIONS: Secure airway, supply oxygen, and begin supportive fluid therapy if necessary.
    11.2.4) DECONTAMINATION
    A) GASTRIC DECONTAMINATION
    1) GENERAL TREATMENT
    a) EMESIS/GASTRIC LAVAGE -
    1) CAUTION: Carefully examine patients with chemical exposure before inducing emesis. If signs of oral, pharyngeal, or esophageal irritation, a depressed gag reflex, or central nervous system excitation or depression are present, EMESIS SHOULD NOT BE INDUCED.
    2) HORSES OR CATTLE: DO NOT attempt to induce emesis in ruminants (cattle) or equids (horses).
    3) DOGS AND CATS
    a) IPECAC: If within 2 hours of exposure: induce emesis with 1 to 2 milliliters/kilogram syrup of ipecac per os.
    b) APOMORPHINE: Dogs may vomit more readily with 1 tablet (6 milligrams) apomorphine diluted in 3 to 5 milliliters water and instilled into the conjunctival sac or per os.
    1) Dogs may also be given apomorphine intravenously at 40 micrograms/kilogram, although this route may not be as effective.
    4) LAVAGE: In the absence of a gag reflex or if vomiting cannot be induced, place a cuffed endotracheal tube and begin gastric lavage.
    a) Pass large bore stomach tube and instill 5 to 10 milliliters/kilogram water or lavage solution, then aspirate. Repeat 10 times.
    5) Do NOT induce emesis in a patient that is already vomiting.
    b) ACTIVATED CHARCOAL/CATHARTIC -
    1) ACTIVATED CHARCOAL: Administer activated charcoal. Dose: 2 grams/kilogram per os or via stomach tube. Avoid aspiration by proper restraint, careful technique, and if necessary tracheal intubation.
    2) CATHARTIC: Administer a dose of a saline or sorbitol cathartic such as magnesium or sodium sulfate (sodium sulfate dose is 1 gram/kilogram). If access to these agents is limited, give 5 to 15 milliliters magnesium oxide (Milk of Magnesia) per os for dilution.
    3) ACTIVATED CHARCOAL/HORSES: Administer 0.5 to 1 kilogram of activated charcoal in up to 1 gallon warm water via nasogastric tube. Neonates: administer 250 grams (one-half pound) activated charcoal in up to 2 quarts water.
    4) ACTIVATED CHARCOAL/RUMINANTS: Administer 2 to 9 grams/ kilogram of activated charcoal in a slurry of 1 gram charcoal/3 to 5 milliliters warm water via stomach tube. Sheep may be given 0.5 kilogram charcoal in slurry.
    5) CATHARTICS/HORSES: Mineral oil is administered 30 minutes after activated charcoal. DOSE: 4 to 6 liters in adult horses and 1 to 4 liters in neonates or foals.
    a) Magnesium sulfate: 0.2 to 0.9 grams/kilogram (500 grams for adults).
    b) The sulfate laxatives are especially effective when given 30 to 45 minutes after mineral oil administration.
    c) Carbachol (lentin): administer 1 milligram to an adult.
    6) CATHARTICS/RUMINANTS & SWINE: Adult cattle: administer 500 grams sodium or magnesium sulfate. Other ruminants and swine: administer 1 to 2 grams/kilogram.
    a) The sulfate laxatives are especially effective when given 30 to 45 minutes after cathartic administration.
    b) Mineral oil: Do not administer within 30 minutes of activated charcoal. DOSE: small ruminants and swine, 60 to 200 milliliters; cattle, 0.5 to 1 gallon.
    c) Magnesium oxide: (Milk of Magnesia) Small ruminants, up to 0.25 gram/kilogram in 1 to 3 gallons warm water; adult cattle up to 1 gram/kilogram in 1 to 3 gallons warm water or 2 to 4 boluses MgOH per os.
    d) Give these solutions via stomach tube and monitor for aspiration.
    7) Do NOT administer cathartic in an animal with severe diarrhea.
    11.2.5) TREATMENT
    A) GENERAL TREATMENT
    1) MAINTAIN VITAL FUNCTIONS - as necessary.
    2) GASTROINTESTINAL TRACT IRRITATION -
    a) Observe patients with ingestion carefully for esophageal or laryngeal burns; if burns are present, consider esophagoscopy to determine their extent.
    b) SUCRALFATE: For relief of gastric irritation or ulceration, administer sucralfate as follows: DOGS: (body weight less than 20 kilograms) 500 milligrams three to four times daily; (weight greater than 20 kilograms) one gram three to four times daily.
    1) Give sucralfate one hour before feeding and wait two hours prior to cimetidine dosing.
    c) CIMETIDINE:
    1) DOGS: 5 to 10 milligrams/kilogram per os, intravenously, or intramuscularly every 6 to 8 hours
    2) CATS: 2.5 to 5 milligrams/kilogram per os, intravenously, or intramuscularly every 8 to 12 hours

Continuing Care

    11.4.1) SUMMARY
    11.4.1.2) DECONTAMINATION/TREATMENT
    A) GENERAL TREATMENT
    1) SUMMARY
    a) Begin treatment immediately.
    b) Keep animal warm and do not handle unnecessarily.
    c) Remove the patient and other animals from the source of contamination or remove dietary sources.
    2) Treatment should always be done on the advice and with the consultation of a veterinarian.
    3) Additional information regarding treatment of poisoned animals may be obtained from a Veterinary Toxicologist or the National Animal Poison Control Center.
    4) ASPCA ANIMAL POISON CONTROL CENTER
    a) ASPCA Animal Poison Control Center, 1717 S Philo Road, Suite 36 Urbana, IL 61802
    b) It is an emergency telephone service which provides toxicology information to veterinarians, animal owners, universities, extension personnel and poison center staff for a fee. A veterinary toxicologist is available for consultation.
    c) Contact information: (888) 426-4435 (hotline) or www.aspca.org (A fee may apply. Please inquire with the poison center). The agency will make follow-up calls as needed in critical cases at no extra charge.
    11.4.2) DECONTAMINATION
    11.4.2.2) GASTRIC DECONTAMINATION
    A) GASTRIC DECONTAMINATION
    1) GENERAL TREATMENT
    a) EMESIS/GASTRIC LAVAGE -
    1) CAUTION: Carefully examine patients with chemical exposure before inducing emesis. If signs of oral, pharyngeal, or esophageal irritation, a depressed gag reflex, or central nervous system excitation or depression are present, EMESIS SHOULD NOT BE INDUCED.
    2) HORSES OR CATTLE: DO NOT attempt to induce emesis in ruminants (cattle) or equids (horses).
    3) DOGS AND CATS
    a) IPECAC: If within 2 hours of exposure: induce emesis with 1 to 2 milliliters/kilogram syrup of ipecac per os.
    b) APOMORPHINE: Dogs may vomit more readily with 1 tablet (6 milligrams) apomorphine diluted in 3 to 5 milliliters water and instilled into the conjunctival sac or per os.
    1) Dogs may also be given apomorphine intravenously at 40 micrograms/kilogram, although this route may not be as effective.
    4) LAVAGE: In the absence of a gag reflex or if vomiting cannot be induced, place a cuffed endotracheal tube and begin gastric lavage.
    a) Pass large bore stomach tube and instill 5 to 10 milliliters/kilogram water or lavage solution, then aspirate. Repeat 10 times.
    5) Do NOT induce emesis in a patient that is already vomiting.
    b) ACTIVATED CHARCOAL/CATHARTIC -
    1) ACTIVATED CHARCOAL: Administer activated charcoal. Dose: 2 grams/kilogram per os or via stomach tube. Avoid aspiration by proper restraint, careful technique, and if necessary tracheal intubation.
    2) CATHARTIC: Administer a dose of a saline or sorbitol cathartic such as magnesium or sodium sulfate (sodium sulfate dose is 1 gram/kilogram). If access to these agents is limited, give 5 to 15 milliliters magnesium oxide (Milk of Magnesia) per os for dilution.
    3) ACTIVATED CHARCOAL/HORSES: Administer 0.5 to 1 kilogram of activated charcoal in up to 1 gallon warm water via nasogastric tube. Neonates: administer 250 grams (one-half pound) activated charcoal in up to 2 quarts water.
    4) ACTIVATED CHARCOAL/RUMINANTS: Administer 2 to 9 grams/ kilogram of activated charcoal in a slurry of 1 gram charcoal/3 to 5 milliliters warm water via stomach tube. Sheep may be given 0.5 kilogram charcoal in slurry.
    5) CATHARTICS/HORSES: Mineral oil is administered 30 minutes after activated charcoal. DOSE: 4 to 6 liters in adult horses and 1 to 4 liters in neonates or foals.
    a) Magnesium sulfate: 0.2 to 0.9 grams/kilogram (500 grams for adults).
    b) The sulfate laxatives are especially effective when given 30 to 45 minutes after mineral oil administration.
    c) Carbachol (lentin): administer 1 milligram to an adult.
    6) CATHARTICS/RUMINANTS & SWINE: Adult cattle: administer 500 grams sodium or magnesium sulfate. Other ruminants and swine: administer 1 to 2 grams/kilogram.
    a) The sulfate laxatives are especially effective when given 30 to 45 minutes after cathartic administration.
    b) Mineral oil: Do not administer within 30 minutes of activated charcoal. DOSE: small ruminants and swine, 60 to 200 milliliters; cattle, 0.5 to 1 gallon.
    c) Magnesium oxide: (Milk of Magnesia) Small ruminants, up to 0.25 gram/kilogram in 1 to 3 gallons warm water; adult cattle up to 1 gram/kilogram in 1 to 3 gallons warm water or 2 to 4 boluses MgOH per os.
    d) Give these solutions via stomach tube and monitor for aspiration.
    7) Do NOT administer cathartic in an animal with severe diarrhea.

References

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    23) Product Information: dopamine hcl, 5% dextrose IV injection, dopamine hcl, 5% dextrose IV injection. Hospira,Inc, Lake Forest, IL, 2004.
    24) Product Information: norepinephrine bitartrate injection, norepinephrine bitartrate injection. Sicor Pharmaceuticals,Inc, Irvine, CA, 2005.
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