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Medical Mushrooms

Medical Mushrooms. Acute Gastroenteritis. Most common manifestation of toxic mushroom ingestion Onset of abdominal cramping, diarrhea, and vomiting within 2 hours of ingestion Self-limited, usually resolving in 12 hours (although wide variability in responses exist)

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Medical Mushrooms

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  1. Medical Mushrooms

  2. Acute Gastroenteritis • Most common manifestation of toxic mushroom ingestion • Onset of abdominal cramping, diarrhea, and vomiting within 2 hours of ingestion • Self-limited, usually resolving in 12 hours (although wide variability in responses exist) • Treatment is supportive with po or iv rehydration

  3. Early Gastroenteritis • Even the common supermarket mushroom can induce an acute gastroenteritis in susceptible individuals Agaricus bisporus (supermarket mushroom)

  4. Early Gastroenteritis • Common mushroom found in eastern and southern North America (especially in lawns) Chloropyllum molybdites (Green-spored parasol)

  5. Early Gastroenteritis • Luminescent, orange-yellow mushroom found in clusters at base or stumps of deciduous trees Omphalotus olearius (Jack-o-Lantern Mushroom)

  6. Delayed Gastroenteritis • Accounts for 95% of deaths due to mushroom ingestion • White, smooth cap, with white gills, not attached to the stalk. Stalk is white, cottony to somewhat pearly, sometimes with a bulbous base. White, large, flaring annulus (ring) is located at the top of the stalk; and cup-like sheath (volva) is found at the base of the stalk. The spores are white. • Heat stable amatoxin binds to RNA polymerase II in hepatocytes and induces liver necrosis Amanita phalloides (Death cap mushroom)

  7. Delayed Gastroenteritis • 3 stages of poisoning • Acute gastroenteritis with profuse, cholera-like diarrhea, starting 5-12 hours after ingestion • Latent period lasting 2-3 days with ongoing liver damage but symptomatic improvement • Clnically apparent hepatic and renal failure • Treatment • For recent ingestion, gastric lavage (< 1 hour) or activated charcoal (< 24 hours) • Volume resuscitation, repletion of electrolytes and glucose • High dose PCN • Silibinin (milk thistle extract) • Charcoal hemoperfusion • Transplant Amanita phalloides (Death cap mushroom)

  8. Delayed Gastroenteritis • Gyromitrin toxin is converted to monomethylhydrazine, a form of rocket fuel, that has CNS, liver, and renal toxicities • Clinical presentation • Onset of abdominal pain, vomiting, diarrhea at 6-10 hours after ingestion • Closely followed by CNS syptoms of weakness, dizziness, headache, confusion, and possibly seizures • May resolve or progress to liver and renal failure • Hemolysis and methemoglobinemia are reported • Treatment • Gastric lavage or charcoal if recent ingestion • Aggressive rehydration • High dose pyridoxine for CNS toxicity • Methylene blue for methemoglobinemia Gyromitra esculenta (false morel)

  9. CNS Syndromes • Psilocybin inhibits serotonin activity • Clinical presentation • Acute onset (15-30 minutes of ingestion) of symptoms ranging from mild euphoria to frank hallucinosis • Treatment is primarily supportive Psylocybe family

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