Pe

Labs

Imaging Gross Pathology Micro Pathology Treatment

Discussion

A 46-year-old girl scour guide presents to the emergency room of the local rural hospital with excessive thirst, weakness, protracted vomiting, acute abdominal pain, and severe diarrhea.

She has been in good health and states that during the camping trip she ate some wild mushrooms (aboui six hours ago) that she had hand-picked.

VS: tachycardia (HR 165); hypotension (BP X5/40). PE: lethargy; disorientation; skin is cold and cyanotic; hyperactive bowel sounds on abdominal exam.

Liver transaminases and bilirubin elevated; FT increased; increased BUN and creatinine.

Thioctic acid, hemodialysis, treat fluid and electrolyte losses aggressively. There are no proven antidotes for amatoxin poisoning. Liver may be damaged to such an extent that transplantation must be considered.

There are many species of toxic mushrooms with clinical pictures according to the specific poison involved. The most commonly involved in the U.S. are Amanita phalloides (delayed intoxication) and Amanita muscaria (rapid toxicity). According to mushroom type, toxins may produce anticholinergic effects (mydriasis, tachycardia, blurred vision) or muscarinic effects (salivation, myosis, bradycardia). These types of mushrooms are often picked and eaten by amateur foragers. Toxins are highly stable and remain after cooking. They are absorbed by intestinal ceils, and subsequent cell death and sloughing occur within 8-12 hours of ingestion. Severe hepatic and renal necrosis is also a common effect of these toxins.

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