Mushroom poisoning

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I am a fan of searching for botanical cures for cancer and the movement to eat local, and eat weeds. But if you choose to forage for plant food, remember that safety trumps enthusiasm. The example I want to discuss is mushroom-hunting, which for some, is a happy pastime and a way to stick it to commercially farmed mushrooms, and for others, turns into a trip to the emergency department and for author and gentleman Nicholas Evans, a kidney transplant.

Make sure that you talk to local experts and read a guide on how to pick mushrooms (such as this Guardian article) so that you can identify the specific mushrooms that grow in your area. David Fischer’s online guide to poisonous American mushroomsis a good place to start. If you have any doubts about the mushroom, take it home or show it to someone who will be able to positively identify it. It is estimated that mushroom toxins can be deadly in up to 50% of children and 20% of adults who are poisoned.

Mushroom hunting is more popular in Europe, so there are more reports of severe/fatal poisonings from Russia, Poland, France, the UK, etc. From my side of the Atlantic, here is a paper from Mexico City that describes two cases of liver toxicity that occurred after ingestion of Amanita mushrooms: one case recovered normal function, while the other one died in multi-organ failure within a week. Amanita mushrooms are especially dangerous because they contain several different toxins, including amatoxins, which cannot be destroyed by cooking or digestive enzymes. A single mature Amanita phalloideae mushroom contains a lethal dose of amatoxins.

The course of Amanita poisoning is divided into four stages. Stage 1 is an asymptomatic period of 6 to 12 hours. Stage 2 is an “upset stomach” period that can involve cramping stomach pain, nausea, vomitting, and watery diarrhea. Stage 3 is the turning point: after 24 to 48 hours of seeming improvement, the toxic effects on liver, kidney, and gut cells causes progressive deterioration of liver and kidney function that may appear as increased prothrombin time, decreased albumin, elevated LFTs, and dark, scant urine production. From here, stage 4 is the march towards liver and kidney failure, which can result in hepatic encephalopathy, bleeding problems, and pH and electrolyte derangements. Liver and kidney transplants, or else dialysis, must be considered by stage 3.

There is no specific antidote for mushroom poisoning, so a treatment plan might involve:

  • resuscitation fluids if the person is dehydrated or hypovolemic
  • in the early hours, sodium bicarbonate or nasogastric lavage followed by activated charcoal to try to flush out the toxins
  • Silymarin (derived from milk thistle), as well as other drugs, like ceftazidime, cimetidine, or N-acetylcysteine (which is used for Tylenol overdoses) have been used empirically but there’s no statistical evidence supporting their use
  • MARS therapy, a form of albumin dialysis used in liver transplantation protocols, although this is an expensive and invasive treatment.