Thread by @EMPoisonPharmD

Toxicologists are often consulted about 🍄foraging misadventures (wild mushroom ingestion).

Usually you don't get a clear mushroom image like this video (at best a blurry photo of some OTHER mushroom), or more often no image.

So what to do?

A 🍄🧵
#FOAMed #FoamCC #MedEd

https://twitter.com/EMPoisonPharmD/status/1671554759843512324

If you do have a good sample or photo you can work with a mycologist (your posion center knows one) to identify the shroom. But this is not frequent.

Since we almost never have that we usually rely on history and symptoms
Key to differentiating mushroom toxicity types: time to onset of GI issues. Most mushrooms upset the tummy. The 5hr “rule” helps identify bad ones.

Early onset toxicity (<5hrs) is usually ok. These are “Little brown mushrooms”.

Funnily they often are not little or brown.

This term encompasses 100s of mushrooms w/ 100s of toxins. but they generally cause self limiting GI symptoms. Here is an example pubmed.ncbi.nlm.nih.gov/2024797/

Sx developing >5hrs could indicate more serious mushrooms. The worst of which is amatoxin containing.

There are genus/species of amatoxin mushroom all over US.

A well known one is Amanita Phalloides ("Death Cap")

Here in WI we have Galerina Autmnalis "Funeral Bell"

Amatoxin causes initial GI after ~6 hours and then liver failure 24-48 hours later. Patient may seem seem fine initially. Have seen bad ones. Most common cause of mushroom induced liver transplant, minimal symptom right after ingestion, easy to miss 😧(pubmed.ncbi.nlm.nih.gov/2334013/).

Another >5hr GI toxic mushroom is gyromitrin. "The false morel"

Causes hepatic injury, seizures, many other effects. The mechanism is wild, hydrazine turns into rocket fuel in body (momonethyl hydrazine) and inhibits GABA production by blocking pyridoxine dependent enzyme.

The goal is to not miss a bad mushroom. Quick onset of isolated GI sx is good, and these patients often go home. Late sx need watching.
Exception: Norleucine mushrooms in the Pacific NW. Early GI toxicity + late renal failure. Good luck triaging there! ncbi.nlm.nih.gov/pmc/articles/P…

While quick onset is usually good, some mushrooms cause early GI symptoms AND other bad symptoms. Fortunately you will usually know.

E.g. 1: Clitocybe/Inocybe mushrooms contain muscarine. Like muscarinic ACETYLCHOINE. Fast-acting, but also cause cholinergic symptoms (diaphorersis, bradycardia etc..) Have seen some bad ones (longdom.org/open-access/de…).

E.g. 2: Psilocybin mushrooms. Also quick, but... usually obvious when consumed.

E.g. 3: Amanita Muscaria (fly agaric), the prototypical mushroom, its literally the emoji🍄

While they have a cool history ingestion causes intoxication/GI symptoms and fortunately not much else. Effects come from muscimol and ibotenic acid (ncbi.nlm.nih.gov/pmc/articles/P…).

This was a quick review of mushroom toxins. There are thousands, (largely though of in about 17 different toxin classes)

Treatment is often supportive, some have limited antidotes, chat with toxicologist or poison center for any ingestions so you don't miss a bad one!

Thanks for coming in for a peek down the tox periscope! 👁️‍🗨️🔬Bonus picture of my gnomes hanging with their shrooms!
#Medtwitter #Toxthursday #Mushrooms #MedEd #TwitteRx #Allmushroomsareediblesomeonlyonce

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