Mushroom Toxicity
There are four major types of mushroom toxins:
If a toxic mushroom ingestion is suspected, follow this guide to mushroom identification:
1. Collect any specimens left at home—preferably uncooked.
2. Collect fresh specimens from gathering site(s).
3. Transport and store mushrooms in paper bags.
4. Spores can be recovered from gastrointestinal fluid.
5. Note initial toxicity and time since ingestion. Note symptoms or lack of symptoms among others ingesting mushrooms.
6. Contact a regional poison information center for assistance in locating an expert in identification.
7. When symptoms are not consistent with the identified species, consider that the person might have ingested another type of mushroom.
Disorders Caused by Gastrointestinal Toxins (Table 41-1)
Signs and Symptoms
Table 41-1
Gastrointestinal Disorders: Causative Mushrooms and Identification
| NAME | DESCRIPTION |
| Chlorophyllum molybdites (green-spored parasol) (see Plate 23) | This summer mushroom has a large, whitish cap (often 10 to 40 cm [3.9 to 15.7 inches] in diameter) that is initially smooth and becomes convex with maturity. Tan or brown warts may be present. The gills are free from the stalk, initially white to yellow and becoming green with maturity. The stalk is 5 to 25 cm (2 to 9.8 inches) long, smooth, and white. The ring is generally brown on the underside. |
| Omphalotus olearius (jack-o’-lantern) (see Plate 24) | This bright orange to yellow mushroom has sharp-edged gills. It often grows in clusters at the base of stumps or on buried roots of deciduous trees. The cap is 4 to 16 cm (1.6 to 6.3 inches) in diameter on a stalk that is 4 to 20 cm (1.6 to 7.9 inches) long. Gills are olive to orange, with white to yellow spores. |
| Amanita flavorubescens and Amanita brunnescens | Both have broad caps (3 to 15 cm [1.2 to 5.9 inches] in diameter) with loosely attached warts. The caps are yellowish to brown. The stalks are 3 to 18 cm (1.2 to 7.1 inches) long, enlarging toward the base with a superior ring. |
Treatment
1. Initiate supportive treatment, including intravenous or oral fluid and electrolyte replacement.
2. For a severe case, administer an antiemetic such as prochlorperazine (Compazine), 2.5 to 10 mg IV or a 25-mg suppository, or ondansetron 4 to 8 mg oral disintegrating tablet or IV.
3. Treat diarrhea with loperamide 4 mg initially, followed by 2 mg after each loose stool, up to 16 mg/day.
Disorders Caused by Disulfiram-Like Toxins (Table 41-2)
Signs and Symptoms
Table 41-2
Disulfiram-like Disorders: Causative Mushroom and Identification
| NAME | DESCRIPTION |
| Coprinus atramentarius (inky cap) (see Plate 25) | This mushroom has a 2- to 8-cm (0.8- to 3.1-inch) cylindric cap on a 4- to 5-cm (1.6- to 2-inch) thin stalk. The cap is white, occasionally orange or yellow at the top, with a surface that is characteristically shaggy. The mature cap often develops cracks at its margins, which turn up. The cap blackens as it matures and then liquefies. |
1. If a person ingests these mushrooms and subsequently ingests alcohol, symptoms similar to those of an alcohol-disulfiram (Antabuse) reaction
