Mushroom poisoning

Many types of mushrooms cause poisoning when taken internally. Distinguishing between wild species is a difficult task, even for an experienced mushroom picker; folk methods for distinguishing poisonous from edible are usually unreliable. If a patient has eaten unknown mushrooms, identifying their type will help in prescribing specific treatment. However, due to the lack of, as a rule, an experienced mycologist, the treatment of such patients is syndromic. If a mushroom sample is available (for example, from vomit), it must be sent to a mycologist for analysis.

According to statistics, poisoning most often occurs with mushrooms that are similar in many ways to edible ones and can be accidentally picked at the same time. However, there are other causes of poisoning: improper preparation, an incorrectly chosen place for picking mushrooms, failure to comply with storage conditions, etc. The more a person is informed about this issue, the more likely it is to avoid negative consequences from consuming our favorite natural product.

ICD 10 code

• T51 – T65 – Exposure to toxic substances not for medical purposes.
• T62 – Intoxication by substances contained in food consumed.
• T62.0 – Intoxication with toxic components contained in eaten mushrooms.

Causes of mushroom poisoning

In most cases, poisoning occurs due to ignorance or insufficient experience in mushroom picking. Poisonous mushrooms can not only be picked by mistake in the forest, but also bought at a spontaneous market where the products sold have not undergone the necessary testing.

The second most common reason may be carelessness in preparing mushroom dishes. Mushrooms take a long time to cook, so some housewives arbitrarily reduce the cooking time, serving the product to the table that has not undergone sufficient heat treatment.

In general, the causes of probable poisoning can be listed as follows:

• toxicity of the mushroom itself used as food (the 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, such as mushroom flies (sciarids);
• consumption of certain types of mushrooms together with alcoholic beverages (for example, with dung beetle (coprinus);
• picking mushrooms near highways, industrial plants, and landfills, which leads to the accumulation of compounds and substances harmful to the body in the product;
• abuse of mushrooms that are considered conditionally edible.

Also, mushrooms can often poison small children, who are not recommended to eat mushroom dishes at all, due to their poor digestibility.

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

Pathogenesis

The mechanism of intoxication associated with the ingestion of poisonous mushrooms may differ slightly, depending on the type of toxic substance.

According to estimates, most poisoning occurs when people consume the following types of mushrooms:

• fly agaric (red, stinking, panther);
• death cap;
• lines, talkers, morels.

The death cap contains a large number of toxic cyclic oligopeptide molecules, which, when ingested, cause gastroenteritis, liver and kidney tissue necrosis, electrolyte imbalance (dehydration) and increased cell permeability. Long-term cooking and drying of mushrooms does not affect the amount of toxic substances in the death cap.

Morels and gyromitra contain substances such as gyromitrin and helvellic acid, which also have a pronounced hemotoxic effect, similar to the effect of the death cap. Toxic components are poorly destroyed by prolonged cooking, but with repeated changes of water during cooking, the level of toxins is significantly reduced.

The red fly agaric and the talker are considered poisonous because they contain the substance muscarine, which has a neurotoxic effect. This effect is similar to acetylcholine. Long-term cooking of such mushrooms leads to partial destruction of muscarine.

A variety of fly agaric known as the panther mushroom contains the anticholinergic substances hyoscyamine and scopolamine.

Symptoms of mushroom poisoning

When using death cap, symptoms develop in three stages:

• Stage I develops within 6-24 hours after ingestion of the poison. The main symptoms are a sharp increase in temperature, bouts of nausea, vomiting, spasms in the stomach and intestines, frequent loose stools (possibly with elements of blood);
• Stage II is the latent period, which lasts about two to four days. During this time, symptoms subside, creating the impression of a beginning recovery;
• Stage III – irreversible consequences develop: liver and kidney tissues are affected, blood clotting is impaired, jaundice and hepatomegaly appear, urination is impaired. Later, convulsive syndrome and comatose state occur. Deterioration occurs quickly and acutely.

When eating red fly agaric or talker mushroom, the first signs appear within 35 minutes (in rare cases up to 2 hours). At first, mild nausea occurs, turning into vomiting. The victim complains of spastic abdominal pain, difficulty breathing, diarrhea. Parasympathetic symptoms are also observed: hyperhidrosis, salivation, lacrimation, constriction of the pupils, bronchospasm, slowing of the heart, decreased blood pressure, collapse. If assistance is not provided, then subsequently there is a disturbance of consciousness (hallucinations, coma), convulsive syndrome develops.

When eating panther fly agaric, thirst and dehydration are observed, pupils dilate, and heart rate increases.

When eating incorrectly heat-treated morels or gyromitra, a feeling of weakness, nausea with vomiting, pain in the epigastric region, diarrhea may occur. In case of severe poisoning, the patient may lose consciousness and may have convulsions. The liver and spleen enlarge.

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 convulsions, including those of the lower jaw. Over time, respiratory failure occurs, and liver failure occurs. If timely assistance is not provided, various complications may develop in the liver, kidneys, and spleen. A fatal outcome is also possible.

Mushroom poisoning during pregnancy is considered very dangerous, because toxic substances and poisons easily penetrate the placental barrier to the unborn child. A woman may suspect poisoning based on the following symptoms:

• discomfort in the digestive tract;
• sudden loss of appetite;
• pain or cramps in the stomach and intestines;
• frequent loose stools, increased gas formation;
• fever, headache;
• impaired consciousness, dizziness.

If any of the above symptoms appear, it is recommended to immediately consult a doctor, because poisoning poses a serious danger to the baby and the pregnancy as a whole.

All poisonous mushrooms cause vomiting and abdominal pain; other symptoms depend on the type of mushroom. Usually, mushrooms that cause symptoms quickly, within 2 hours, are less dangerous than those that cause symptoms later (after 6 hours or more).

Mushrooms [Chlorophyllum molybdites, small brown mushrooms often found growing in lawns], poisoning with which manifests itself early gastrointestinal symptoms, causing gastroenteritis, sometimes headache and muscle pain. Diarrhea with blood may develop. Symptoms usually resolve within 24 hours.

Hallucinogenic mushrooms cause early neurological symptoms and are often eaten recreationally because they contain psilocybin (a hallucinogen). The most commonly used mushrooms are those of the Psilocybe family, but some other mushrooms also contain psilocybin. Symptoms develop within 30 minutes and include euphoria, hallucinations, and heightened imagination. Tachycardia and hypertension are also observed, and some children develop hyperpyrexia, but serious disorders are rare. Patient sedation (with benzodiazepines) is sometimes required.

Inocybe and Clitocybe species cause an early anticholinergic (muscarinic-like) syndrome. Symptoms include SLUDGE syndrome, miosis, bronchorrhea, bradycardia, sweating, wheezing, and fasciculations. Symptoms are usually mild, begin within 30 minutes, and resolve within 12 hours. Atropine may be used for severe anticholinergic syndrome (bradycardia, bronchorrhea).

Mushrooms of the Amanita and Gyromitra Cortinarius families cause delayed gastrointestinal symptoms. The most toxic mushroom of the Amanita family is Amanita phalloides. This mushroom accounts for 95% of deaths from mushroom poisoning. Primary gastroenteritis, which develops 6-12 hours after consumption, can be severe; hypoglycemia is possible. Initial symptoms subside within a few days, then liver failure and, in some cases, kidney failure develop. First aid includes monitoring blood glucose concentration and taking activated charcoal. Liver failure may require liver transplantation; the effectiveness of other specific treatments (acetylcysteine, high doses of penicillins, silibinin) has not been proven.

Poisoning with mushrooms of the Gyromitra family may present with hypoglycemia, occurring simultaneously with or immediately after the onset of gastroenteritis. Other effects may include CNS toxicity (convulsions) and hepatorenal syndrome, occurring after a latent period of several days. Initial management includes monitoring of plasma glucose concentrations and administration of activated charcoal. Neurological symptoms are treated with pyridoxine at a dose of 25 mg/kg body weight (maximum daily dose 25 g); supportive therapy in case of liver failure.

Most representatives of the Cortinarius family of mushrooms are common in Europe. Gastroenteritis symptoms can last for 3 days. Within 3-20 days from the moment of poisoning, signs of renal failure (lower back pain, decreased diuresis) are possible, which often resolves on its own.

Diagnostics

General principles of diagnosis are based on the following sequential steps:

• evaluation of anamnesis data, examination of the patient, identification of specific signs of poisoning;
• results of laboratory tests, qualitative and quantitative assessment of toxic components in the bloodstream, urine or cerebrospinal fluid;
• forensic medical examination (in case of death).

Instrumental diagnostics (functional studies):

• Electroencephalography helps to determine changes in brain bioactivity for the diagnosis of hallucinogen poisoning;
• An electrocardiogram is used to determine the degree of toxic effects on the cardiovascular system, heart rhythm and conductivity;
• Electroplethysmography helps to measure the main parameters of systemic hemodynamics;
• Radionuclide methods are used to assess toxic damage to the liver and kidneys.

Laboratory diagnostics (tests) include:

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

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

The final diagnosis of mushroom poisoning is established by a toxicologist based on the results of all studies conducted.

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

Treatment of mushroom poisoning

Patients with severe poisoning may require mechanical ventilation and/or treatment for cardiovascular collapse. If consciousness is impaired, constant

If you notice signs of mushroom poisoning, you should immediately contact a doctor or call an ambulance. You should definitely inform the doctor about what mushrooms and in what quantities you ate, how they were prepared, and also list the people who ate the mushroom dish with you.

The first step in providing assistance in case of 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 carbon, sorbex, enterosgel). In a hospital, a doctor can prescribe an antidote if the type of poisonous mushroom consumed is reliably known. The patient's condition is monitored by a doctor for several days, after which he is discharged home.

In severe cases, infusion therapy, forced diuresis, and hemosorption (during the first day after poisoning) may be prescribed.

First aid for mushroom poisoning can be provided at home, before the doctor arrives. The victim is given a large amount of milk or water with the addition of soda or potassium permanganate (a little, until a slightly pink solution is obtained). After this, a gag reflex is induced. It is recommended to perform this procedure several times until the stomach is completely cleared. After the digestive tract is cleared, the victim should be kept at rest, laid horizontally, given a sorbent, warm tea.

Are there any special medications prescribed for mushroom poisoning?

After eating fly agaric, an antidote such as atropine is administered (0.1%, 1 ml subcutaneously, up to 4 times every half hour). To eliminate bronchospasm, isadrine or euphyllin are used in standard dosages. Caffeine is administered to support cardiac activity. It is not recommended to use acid-based drugs, since an acidic environment promotes the absorption of the toxic substance muscarine.

After eating death cap, russula or pig, treatment is aimed at restoring the water-electrolyte balance and preventing a collapse state. All kinds of plasma substitutes are used, which are administered to the body drop by drop, from 3 to 5 liters per day. This can be Ringer's solution, saline, polyglucin, etc. To correct blood pressure, adrenal cortex hormones are prescribed. Antibiotics and cardiac drugs (for example, strophanthin) are also used according to indications.

Homeopathy is rarely used for poisoning, since such drugs have not yet been sufficiently studied, and mushroom intoxication requires clear and rapid treatment measures. Homeopathic drugs can be used after the dangerous period of poisoning has passed, to restore the body, but only after consulting a doctor.

Folk remedies

Treatment with herbs and folk remedies is allowed only after providing mandatory first aid. A doctor's consultation should be mandatory.

In no case should you practice drinking alcohol or alcohol-containing solutions or tinctures in case of poisoning - ethyl alcohol facilitates the absorption of toxic substances into the body.

The following remedies are allowed (only after gastric lavage):

• take a mixture of milk and egg white;
• drink freshly squeezed potato juice;
• drink fennel infusion with honey;
• drink a decoction of valerian root (1 teaspoon per 500 ml of water, boil for 5 minutes);
• drink rice broth, and also consume undercooked rice grains (as a sorbent).

In addition, you can do an enema with chamomile infusion or take a saline laxative. Drink strong black tea throughout the day.

[ 12 ], [ 13 ], [ 14 ]

Prevention of mushroom poisoning

If you like to pick or eat mushrooms, you need to know about simple principles of preventing possible poisoning. This will help preserve the health and life of you and your loved ones.

• You should not put unknown or unfamiliar mushrooms in your basket.
• Avoid old and rotten mushrooms.
• Watch your children closely and explain to them that not all beautiful mushrooms can be picked, and even more so, it is unacceptable to try them raw.
• Carefully inspect each specimen individually.
• Inspect the honey mushrooms for the presence of plates under the cap.
• It is not recommended to collect mushrooms in plastic bags; use wicker baskets for this purpose.
• Do not leave the processing of collected mushrooms “for later”, clean them and boil them immediately after collecting them.
• Cook the mushrooms for a sufficient amount of time. Be sure to pour out the broth.
• When using canned mushrooms, pay attention to the expiration date of the product, the integrity of the can and the lid. If the lid is swollen or mold has formed under it, then such a product should not be consumed.
• You should also not pick mushrooms near highways, industrial zones, or landfills.

Forecast

The most unfavorable situation can arise with death cap poisoning: the mortality rate from intoxication can be from 50 to 90% when consuming one or two mushrooms. If a person eats more than 3 mushrooms, then in 100% of cases a fatal outcome occurs.

When consuming other types of mushrooms, the situation can develop according to two scenarios:

• if treatment is started on time, complete recovery will soon occur;
• If assistance is not provided, then in half of the cases death occurs within 5-8 days.

Mushroom poisoning is a very dangerous condition for the body and a huge burden for all organs. Therefore, you should be careful when eating mushroom dishes. Be healthy!

[ 15 ]