Clinical approach to toxic mushroom ingestion

This review provides the physician with a clinical approach to the diagnosis and management of toxic mushroom ingestion. It reviews the recent literature concerning proper management of seven clinical profiles.

Using the key words "mushroom poisoning," "mushroom toxicology," "mycetism," "hallucinogenic mushroom ingestion," and "Amanita poisoning," the MEDLINE files were searched for articles pertinent to the practicing physician. Much of the original data were gathered at the Aspen Mushroom Conference held each summer throughout the 1970s at Aspen, Colorado, sponsored by Beth Israel Hospital and the Rocky Mountain Poison Center. Texts related to poisonous plants and specific writings concerning mushroom poisoning were also consulted; many of these texts are now out of print.

The 100 or so toxic mushroom groups can be divided into seven clinical profiles, each of which requires a specific clinical approach. Two of the seven groups (amanitin and gyromitrin) have a delay in onset of symptoms of up to 6 hours following ingestion and provide essentially all the major mobility and mortality associated with toxic mushroom ingestion. These two groups are the major focus of this review. Treatment of the potential mushroom ingestion, as well as guidelines for asking clinical questions, are included. These questions serve as a form of algorithm to assist the clinician in arriving at the correct toxic group.