Muscarinic poisoning from medications and mushrooms. A puzzling symptom complex

A mixture of signs and symptoms can occur with muscarinic poisoning from medications or mushrooms. Manifestations may vary even among persons who ingested mushrooms grown in the same patch and gathered at the same time. Confusion can occur if mushroom poisoning is attributed to a suspected species rather than to the toxin suggested by signs and symptoms. Accurate diagnosis depends on clinical suspicion and recognition of muscarinic manifestations, notably diaphoresis, salivation, bladder cramping, diarrhea, and difficulty with visual accommodation. Muscarinic toxicity due to medications necessitates an adjustment in drug dosage. In mushroom poisoning that produces primarily muscarinic effects, atropine is the treatment of choice.