Version May 2024
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222, or the nearest international regional poison center. Contact information for regional poison centers around the world is available at the website referenced below.[1] | ||||||
| Mushroom poisoning syndrome | Toxins | Onset of symptoms | Sites of toxicity | Specific mushroom examples | Treatment* | Mortality |
| Acute gastroenteritis without liver failure | GI irritants | <6 hours (most within 3 hours) | GI tract | Chlorophyllum molybdites Clitocybe nebularis Omphalates illudens | Supportive care: IV fluid repletion as needed | Mortality rare, symptoms typically resolve within 6 hours |
| Hallucinogenic | Psilocybin, psilocin | 30 minutes-2 hours | CNS (hallucinogenic effects) | Psilocybe cubensis P. mexicana Conocybe cyanopus Gymnopilus aeruginosa Panaeolousfoenisecil | Benzodiazepines for agitation Supportive care | Mortality rare, symptoms typically resolve within 12 hours |
| CNS excitation and depression (stupor, coma, delirium, agitation, hallucinations, and, in children, seizures) | Ibotenic acid, muscimol | 30 minutes-2 hours | CNS (depressant and excitatory effects) | Amanita muscaria A. pantherina A. gemmata | Benzodiazepines (eg, lorazepam 0.05 mg/kg, maximum dose 2-4 mg) for agitation Supportive care | Mortality rare, symptoms typically resolve within 6-24 hours |
| Cholinergic excess (vomiting, diarrhea, bradycardia, bronchorrhea, bronchospasm, salivation, tearing) | Muscarine | 30 minutes-2 hours | Autonomic nervous system (muscarinic receptors) | Clitocybe dealbata C. illudens Inocybe fastigiata Boletus calopus | Atropine (0.02 mg/kg IV, minimum dose 0.1 mg, maximum dose 1 mg) OR Glycopyrrolate (10 mcg/kg, maximum dose 0.2 mg) Repeat anticholinergic agent as needed until bronchial secretions have dried Supportive care: IV fluid resuscitation of vomiting and diarrhea, inhaled albuterol and ipratropium bromide for bronchospasm | Mortality rare, symptoms typically resolve within 12 hours |
| Disulfuram-like reaction (flushing, headache, tachycardia, chest pain, anxiety) | Coprine | 30 minutes-2 hours | Inhibition of aldehyde-dehydrogenase enzyme leading to increased blood aldehyde | Coprinus atramentarius Clitocybe clavipes | Supportive care | Mortality rare, symptoms typically resolve within 6 hours |
| Gastroenteritis and delayed onset renal failure | Allenic norleucine | 30 minutes-3 hours (GI toxicity) 12-24 hours (renal toxicity) | Kidney GI tract | Amanita smithiana | Supportive care: As for renal insufficiency Hemodialysis | Mortality rare, full recovery of renal function in most patients |
| Delayed liver toxicity and delayed gastroenteritis | Cyclopeptides:
| 6-24 hours¶ | GI tract Liver Kidney | Amanita phalloides A. virosa A. verna A. bisporigera Galerina autumnalis G. marginata G. venenata Lepiota helveola | Multiple dose activated charcoal IV SilibininΔ IV N-acetylcysteineΔ IV cimetidineΔ IV vitamin CΔ Supportive care: IV fluid resuscitation for hypovolemia; supportive treatment of liver failure and hepatorenal syndrome◊ Liver transplant | 2-30% |
| Seizures, delayed gastroenteritis and liver toxicity | Gyromitrin | 4-10 hours | GI tract Central nervous system Liver Blood | Gyromitra esculenta G.infula Sarcosphaera coronaria Cyathipodia macropus | Seizures: Benzodiazepines and pyridoxine (70 mg/kg IV, maximum dose: 5 grams) Methemoglobinemia: Methylene blue (1-2 mg/kg IV, slowly over 5 minutes for symptoms or methemoglobin level >20%) Supportive care: IV fluid resuscitation for delayed vomiting and diarrhea | 0-10% |
| Delayed renal failure | Orellanine, orellinine, cortinarin | 3-20 days | Kidney | Cortinarius orellanus C. speciosissinus Mycena pura Omphalatus orarius | Supportive care: As for renal insufficiency Hemodialysis Renal transplant | Rare, end-stage renal failure 11%, renal transplant 13% |
| Delayed rhabdomyolysis | Unknown | 24-72 hours | Muscle | Tricholoma equestre | Supportive care: IV fluid repletion and correction of hyperkalemia Hemodialysis | 25% |
| Erythromelalgia (burning extremity pain with erythema and edema, severe tactile pain) | Acromelic acid | >24 hours | Peripheral nerves Skin | Clitocybe acromelalga | Supportive care: Pain management | Mortality rare, symptoms may last for months |
| Delayed encephalopathy | ||||||
| Patients with renal failure | Unknown | >24 hours to days | Encephalopathy | Pleurocybella porrigens§ | Supportive care | 27% |
| Normal healthy patients | Polyporic acid (causes violet colored urine) | >12 hours | Encephalopathy, liver and renal toxicity | Hapalopilus rustilans | Supportive care | Rare |
| Immune-mediate hemolytic anemia | Antibodies to Paxillus involutus | Repeated ingestion of cooked mushroom | Blood | Paxillus involutus | Supportive care: As for autoimmune hemolytic anemia. Renal insufficiency may occur. | Rare |
| Shiitake dermatitis | Lentinan | 2 hours to 5 days after consumption of raw or undercooked shiitake mushrooms | Skin | Lentinula edodes | For severe cases, antihistamines and systemic corticosteroids | None |
| Allergic bronchioalveolitis | Allergic reaction to spores of Lycoperdon species | <6 hours | Lungs | Lycoperdon species | Corticosteroids Antifungal agents (eg, Amphotericin B) | Rare |
Reference:
Data from:
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