Poisoning with mushrooms

Many types of fungi when ingested cause poisoning. Distinguishing wild species is a difficult task, even for a knowledgeable mushroom picker, alternative ways to distinguish between poisonous and edible are, as a rule, unreliable. If the patient ate unknown fungi, establishing their type will help in the appointment of a specific treatment. However, in view of the absence, as a rule, of an experienced mycologist, the treatment of such patients is syndromic. In the presence of a sample of the fungus (for example, from vomit), it is necessary to send it to the mycologist for analysis.

According to statistics, most often there is poisoning with mushrooms, which by many features are similar to edible and can be accidentally collected simultaneously with them. However, there are other causes of poisoning: improper cooking, incorrectly chosen place for collecting mushrooms, non-observance of storage conditions, etc. The more a person is informed on this issue, the greater the probability of avoiding the negative consequences from using the natural product we so fond of.

ICD Code 10

• T51 - T65 - Exposure to toxic substances not having a medical purpose.
• T62 - Intoxication with substances that are contained in food.
• T62.0 - Intoxication with toxic components that were contained in the eaten mushrooms.

Causes of poisoning with mushrooms

In most cases, poisoning occurs due to ignorance or lack of experience in picking mushrooms. Poisonous mushrooms can not only be collected by mistake in the forest, but also bought in a spontaneous market, where the products sold did not pass the necessary verification.

The second most common cause may be negligence in the preparation of mushroom dishes. Mushrooms are prepared long enough, so some housewives arbitrarily shorten the cooking time by feeding to the table a product that has not undergone sufficient heat treatment.

In general, the causes of possible poisoning can be identified by the following list:

• the toxicity of the fungus itself, consumed as food (presence of mycotoxic substances);
• long-term storage of fresh unprocessed mushrooms, or improper storage of ready-made dishes;
• damage to the fungus by parasites and insects, for example, mushroom flies (syarids);
• the use of certain types of fungi in conjunction with alcoholic beverages (for example, with dung (coprinus));
• picking up mushrooms near roads, industrial enterprises, dumps, which leads to accumulation of harmful compounds and substances in the product;
• abuse of mushrooms, which belong to conditionally edible representatives.

Also, often fungi can poison young children who are not recommended to eat mushroom dishes in general, because of their poor digestibility.

[1], [2], [3], [4], [5]

Pathogenesis

The mechanism of intoxication, associated with the intake of poisonous fungi, may differ somewhat, depending on the variety of the damaging toxic substance.

It is estimated that most of the poisonings people get when using the following mushroom species:

• fly agaric (red, smelly, panther);
• death cap;
• lines, govorushki, morels.

In the pale toadstool, a large number of toxic cyclic oligopeptide molecules are found which, upon ingestion into the digestive system, provoke the development of gastroenteritis, necrosis of liver and kidney tissue, electrolyte exchange (dehydration), and increased cell permeability. Long cooking and drying of mushrooms do not affect the amount of toxic substances in the pale toadstool.

In the lines and morels contain substances such as gyromitrin and helvellic acid, which also have a pronounced hemothoxic effect, close to the effects of pale toadstool. Toxic components are not easily degradable during prolonged cooking, but with repeated water changes during cooking, the level of toxins is significantly reduced.

Red fly agaric and golovoroshka are considered poisonous because of the content of muscarinic substance in them, which has a neurotoxic effect. This action is similar to acetylcholine. Continuous cooking of such fungi leads to partial destruction of muscarin.

This kind of fly agaric, like a panther mushroom, contains cholinolytic substances hyoscyamine and scopolamine.

Symptoms of poisoning with mushrooms

With the use of pale toadstool, the symptomatology has three stages of development:

• Stage I develops throughout 6-24 hours after taking poison for food. The main signs are a sharp increase in temperature, bouts of nausea, vomiting, spasms in the stomach and intestines, rapid fluid stools (possibly with elements of blood);
• II stage is a latent period, which lasts about two to four days. Symptoms at this time subsided, gives the impression of a beginning recovery;
• Stage III - irreversible effects develop: liver and kidney tissues are affected, blood coagulation is disrupted, jaundice, hepatomegaly appears, urination is impaired. Later there is a convulsive syndrome, a coma. Deterioration comes quickly and sharply.

When eating red mushroom or mushroom-govorushka, the first signs appear after 35 minutes (in rare cases, up to 2 hours). In the beginning, there is a slight nausea, resulting in vomiting. The victim complains of spastic pain in the abdomen, shortness of breath, diarrhea. Parasympathetic symptoms are also observed: hyperhidrosis, salivation, lacrimation, narrowing of pupils, bronchospasm, slowing of cardiac activity, lowering of blood pressure, collapse. If no help is provided, then there is a violation of consciousness (hallucinations, falling into a coma), convulsive syndrome develops.

When eating panther fly agaric, thirst, dehydration of the body, pupils dilate, heart activity becomes more frequent.

When you use improperly heat-treated stitches or morels, you may experience a feeling of weakness, nausea with vomiting, tenderness in the epigastric region, diarrhea. With severe poisoning, the patient may lose consciousness, he may experience seizures. The liver and spleen are enlarged.

Mushroom poisoning in children is more severe, due to the weakness and imperfection of their digestive system. Most often in childhood, the initial sign of poisoning is seizures, including the lower jaw. Over time, there are malfunctions of the respiratory function, liver failure occurs. If there is no timely assistance, various complications can develop from the liver, kidneys, and spleen. A lethal outcome is also possible.

It is very dangerous to poison mushrooms during pregnancy, because toxic substances and poisons easily penetrate the placental barrier to the future child. A woman can suspect poisoning already on the following symptoms:

• discomfort in the digestive tract;
• a sharp loss of appetite;
• pain or cramping in the stomach and intestines;
• frequent loose stools, increased gas production;
• fever, headache;
• impaired consciousness, dizziness.

At occurrence of any of the above-stated signs it is recommended to address urgently to the doctor, after poisoning represents serious danger for the kid and pregnancy as a whole.

All poisonous mushrooms cause vomiting and pain in the abdomen; other symptoms depend on the type of fungus. Usually fungi that cause symptoms quickly, within 2 hours, are less dangerous than those whose poisoning symptoms occur later (after 6 hours or more).

Mushrooms [Chlorophyllum molybdites, small brown mushrooms, often growing on lawns), poisoning which manifests itself with early gastrointestinal symptoms, cause gastroenteritis, sometimes headache and muscle pain. Perhaps the development of diarrhea with an admixture of blood. Symptoms usually resolve within 24 hours.

Mushrooms-hallucinogens cause early neurologic symptoms, they are often eaten for entertainment, since they contain psilobicin (hallucinogen). Most commonly used are members of the family Psilocybe, but psilobicin contains some other species of fungi. Symptoms develop within 30 minutes and include euphoria, hallucinations and increased imagination. There is also tachycardia and hypertension, some children experience hyperpyrexia, but serious disorders are rare. Sometimes patient sedation (using benzodiazepines) is required.

Representatives of the families of Inocybe Clitocybe cause an early holinolitic (muscarinic-like) syndrome. Symptoms include SLUDGE-syndrome, miosis, bronchorrhoea, bradycardia, sweating, wheezing and fascination. Symptoms usually not clearly expressed, begin within 30 minutes and disappear within 12 hours. At the expressed displays of a holinolitic syndrome (a bradycardia, a bronchorea) it is possible to use atropine.

Fungi of the families Amanita, Gyromitra Cortinarius cause delayed gastrointestinal symptoms. The most toxic fungus from the Amanita family is Amanita phalloides. 95% of deaths from fungal poisoning account for this fungus. Primary gastroenteritis, which develops 6-12 hours after ingestion, may be severe; hypoglycemia is possible. The initial manifestations weaken over a period of several days, then the hepatic and, in some cases, renal failure develop. First aid includes monitoring of blood glucose concentration and intake of activated charcoal. With hepatic failure, liver transplantation may be required; the effectiveness of other specific treatments (acetylcysteine, high doses of penicillins, silibinin) has not been proven.

The poisoning by the fungi of the Gyromitra family can be manifested by hypoglycemia, which occurs simultaneously or immediately after the appearance of gastroenteritis. Other effects may include toxic CNS damage (convulsions) and hepatorenal syndrome that occur after several days of latent period. Initial management includes monitoring of plasma glucose concentration and the assignment of activated carbon. For the treatment of neurological symptoms, pyridoxine is used at a dose of 25 mg / kg of body weight (maximum daily dose of 25 g); Supportive therapy in case of liver failure.

Most representatives of the family of Cortinarius fungi are common in Europe. The phenomena of gastroenteritis can last 3 days. Within 3-20 days from the moment of poisoning, there may be signs of renal failure (low back pain, decreased diuresis), which is often resolved independently.

Diagnostics

The general principles of the diagnosis are based on the following sequential actions:

• assessment of the history of the patient, examination of the patient, identification of specific signs of poisoning;
• results of laboratory studies, qualitative and quantitative assessment of toxic components in the bloodstream, in urine or CSF;
• forensic medical examination (with lethal outcome).

Instrumental diagnostics (functional studies):

• electroencephalography helps to determine changes in the bioactivity of the brain for the diagnosis of hallucinogen poisoning;
• an electrocardiogram is used to determine the degree of toxic effects on the cardiovascular system, on the heart rate and conductivity;
• electroplethysmography helps to measure the basic parameters of systemic hemodynamics;
• radionuclide methods are used to assess the toxic damage of the liver and kidneys.

Laboratory diagnostics (analyzes) includes:

• toxicological studies of the biological environment of the body (blood, urine, cerebrospinal fluid);
• specific analysis to assess changes in the biochemical composition of the blood;
• nonspecific diagnostic methods for determining the severity of intoxication damage to the liver, kidneys and other organs.

Differential diagnosis is carried out with the usual food intoxication, with gastroenteritis, dysentery or infectious hepatitis.

The final diagnosis of fungal poisoning is established by a toxicologist on the basis of the results of all the studies performed.

[6], [7], [8], [9], [10], [11],

Treatment of mushroom poisoning

Patients with severe poisoning may require mechanical ventilation and / or treatment of cardiovascular collapse. In the case of mental disorders, a permanent

If signs of poisoning with fungi are found, you should immediately call your doctor or call for "emergency help." Be sure to inform the doctor of what kind of mushrooms and how much you used, how they were cooked, and also to list people who ate a mushroom dish with you.

The first measure to help with poisoning should be gastric lavage. The victim should drink as much water as possible and induce vomiting, after which it is necessary to take a sorbent (for example, activated charcoal, sorbex, enterosgel). In a hospital, a doctor can prescribe the administration of an antidote if the species of the poisonous fungus used is known reliably. The patient's condition is established by medical observation for several days, after which he is discharged home.

In severe cases, infusion treatment, forced diuresis, hemosorption (within the first day after poisoning) can be prescribed.

First aid for poisoning with mushrooms can be provided at home, before the arrival of a doctor. The victim is allowed to drink a large amount of milk or water with the addition of soda or potassium permanganate (slightly, until a slightly pink solution is obtained). After that, the gag reflex is caused. This procedure is recommended to be done several times, until the stomach is completely cleansed. After cleansing the digestive tract, the victim needs to ensure peace, lay it horizontally, give a sorbent, warm tea.

Do you prescribe any special medicines for poisoning with mushrooms?

After using fly agaric, an antidote such as atropine (0.1% in 1 ml of capillary, up to 4 times every half hour) is administered. To eliminate bronchospasm, use isadrin or euphyllin in standard dosages. Caffeine is administered to support cardiac activity. It is not recommended to use drugs based on acids, since the acidic medium promotes the absorption of the toxic substance of muscarin.

After eating pale toadstool, freckles or swine, the treatment is directed to restore the water-electrolyte balance and prevent a collapoid state. All kinds of plasma substitutes are used, which are introduced into the body by drop, from 3 to 5 liters per day. It can be Ringer's solution, saline solution, polyglucin, etc. Blood hormone supplements are prescribed for correction of blood pressure. Also used antibiotics, cardiac drugs (for example, strophanthin) according to the indications.

Homeopathy for poisoning is rarely used, as such drugs have not been sufficiently studied, and intoxication with fungi requires clear and rapid medical measures. Homeopathic preparations can be used after the end of a dangerous poisoning period, to restore the body, but only after consulting a doctor.

Alternative treatment

Treatment with herbs and alternative means is allowed only after the provision of mandatory first aid. A doctor's consultation should be mandatory at the same time.

In no case can you practice with poisoning the use of alcohol and alcohol-containing solutions or tinctures - ethyl alcohol helps to facilitate the absorption of poisonous substances into the body.

The following drugs are allowed (only after washing the stomach):

• take a mixture of milk and egg white;
• drink freshly squeezed juice from potatoes;
• drink infusion of fennel with honey;
• drink a decoction of valerian root (1 tsp for 500 ml of water, boil for 5 minutes);
• drink a decoction of rice, as well as ingestion of undercooked rice grains (as a sorbent).

In addition, you can put an enema with infusion of chamomile, or take a salt laxative. During the day, drink strongly brewed black tea.

[12], [13], [14]

Prevention of fungal poisoning

If you like to collect or consume mushrooms, then you need to know about simple principles of preventing possible poisonings. This will help to preserve health and life for you and your loved ones.

• Do not put in the basket unknown or unfamiliar mushrooms.
• Avoid old and rotten mushrooms.
• Closely monitor the children, explain to them that not all beautiful mushrooms can be collected, and even more, it is unacceptable to try them raw.
• Thoroughly inspect each copy separately.
• Examine the mushrooms for the presence of plates under the cap.
• It is not recommended to collect the mushroom crop in plastic bags, use woven baskets for this.
• Do not leave the processed mushrooms "for later", clean them and boil them immediately after they are collected.
• Cook the mushrooms for a sufficient amount of time. Always pour out the broth.
• When consuming mushroom canned foods, pay attention to the shelf life of the product, the integrity of the can and lid. If the lid is swollen, or mold is formed under it, then such a product should not be consumed.
• Also, you should not collect mushrooms near highways, industrial zones, dumps.

Forecast

The most unfavorable situation can occur when poisoning with pale toadstool: the percentage of death from intoxication can be from 50 to 90% with the use of one or two fungi. If a person takes into food more than 3 mushrooms, then in 100% of cases there is a lethal outcome.

With the use of other types of fungi, the situation can develop in two scenarios:

• if the treatment is started on time, then a full recovery soon occurs;
• if assistance has not been provided, then in half of the cases a fatal outcome occurs during 5-8 days.

Poisoning with mushrooms is a very dangerous condition for the body and a huge load for all organs. Therefore, you should be careful when using mushroom dishes. Be healthy!

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