CURRENT Essentials of Critical Care.pdf

252 Current Essentials of Critical Care■■■Mushroom PoisoningEssentials of Diagnosis• Cyclopeptides (including Amanita phalloides, Galerina marginata):6–12 hours after ingestion, colicky abdominal pain, profusediarrhea, nausea, vomiting; latent phase for 3–5 days, thenhepatic toxicity phase with liver failure• Gyromitrins: 6–12 hours post ingestion, gastritis, dizziness,bloating, nausea, vomiting, headache; if severe, hepatic failure3–4 days after ingestion; seizure, coma• Other mushrooms cause symptoms early, usually 1–2 hours;several cause hallucinations, altered perceptions, drowsiness• 50% of ingestions and 95% of deaths from cyclopeptide group;gyromitrin responsible for remainder of fatal ingestionsDifferential Diagnosis• Gastroenteritis• Infectious diarrhea• Hepatic failure (acetaminophen toxicity, viral hepatitis, alcohol)Treatment• Gastric emptying if 4 hours after ingestion; repeated-dose activatedcharcoal if after 4 hours.• Supportive care for hepatic failure; if severe, liver transplantation• Thioctic acid, silybin, penicillin G, N-acetylcysteine used in cyclopeptidegroup toxicity; benefit not validated• Methylene blue for methemoglobinemia associated with gyromitringroup; pyridoxine for refractory seizures■ PearlOf the 500 species of mushrooms in the United States, 100 are toxicand 10 are potentially fatal.ReferenceEnjalbert F et al: Treatment of amatoxin poisoning: 20-year retrospective analysis.J Toxicol Clin Toxicol 2002;40:715. [PMID: 12475187]