MUSHROOMS

5000 SPECIES (2%)

Cyclopeptide Toxin

Amanita phalloides (death cap) A. verna A.virosa

Galerina marginata

1-Amatoxins› Α-amanitin › β-amanitin

2-Phallotoxin› Phalloidin

Amatoxin:high oral absorb, entrohepatic

circulation, renal reabsorptionPhallotoxin:very low oral absorption (no oral

toxicity)Both: heat stable

Amatoxin

Inhibit RNA polymerase ║ Interfere DNA Transcription

Protein Synthesis Necrosis

Amatoxin target

Liver KIDNEY

PANCREAS

INTESTINE

phallotoxin

Bind to actin Disrupt cell membrane liver protein synthesis

Clinical

1-- GI effect (6-24h)› Abdominal pain› nausea› vomiting› Diarrhea› Fever› Hypoglycemia› elecrolyte imbalance

CLINICAL

2- Temporary clinical remission (24-72h)

Toxin induce cell injury (misdiagnose)

CLINICAL

3--Hepatorenal phase (3-6 days)› Hepatic-renal failure› Pancreatitis› Coagulophaty› Seizure› Coma

Treatment

Lavage Charcoal Diuresis Electrolyte balance Vit K FFP Glucose

Penicillin G

300,000-One million IU/Kg (seizure)

Displace toxin from protein binding renal excretion

Silymarin

140 mg TID Inhibit toxin uptake by cells NAC– thioctic acid– hyperbaric(oxygen) regenerate Hemodialysis- hemopefusion

late

Gyromitrin toxin (heat labile)

Gyromitra esculenta gyromitrin GI methyl formyl hydrazine GI

Methyl

Hydrazine

metabolites toxicity

Inhibit Pyridoxal Phosphate GABA

seizure liver Nitrosamide Liver Toxicity Inhibit histaminase His GI

effect Inhibit Dihydrofolate Reductase

Anemia

Induce oxidative Stress Hemolysis , Methemoglobinemia

Clinical (after 6h)

GI: nausea-vomit-abdo pain-diarrhea CNS: dizziness-headache-seizure-

coma Liver: ALT and AST-coagulopathy-

jaundice Blood: hemolysis-metHb-anemia- others: hypotension-rhabdomyolysis

treatment

metHb > 30% ---- methylene blue + o2 supp

Folinic acid : 5-15 mg/day for 7 day Pyridoxine: up to 25 mg/kg +diazepam

seizure Vit K – fluid (ringer-lactat) alkaline

urine prevent myoglobin deposition

MUSCARINE Heat stable Low oral absorbtion Clitocybe Inocybe No effect on nicotinic receptor No CNS effect

CLINICAL (0.5 – 1h)

Cholinergic: › salivation › lacrimation› Diarrhea› Bradycardia› Hypotension› perspiration

Treatment

Lavage Charcoal Ipratropium (inhalation) Atropine Glycopyrolate (0.5 to 1 mg ) IV No CNS effect

AMANITA MUSCARIAAND

AMANITA PANTHERINA

ISOXAZOLE COMPOUND

Ibotenic acid NMDA activation excitation

muscimol GABA agonist depression

serotonin , dopamine

CLINICAL (0.5 TO 2 h)

Ephoria depression Agitation somnolence Amnestic to event during intoxication GI effect – tremor –ataxia –

hallucination-salivation-perspiration-bradycardia

no effect on muscarinic receptors

Treatment

Charcoal Quiet, dark room Diazepam in agitation No role for atropine Poison exctract by water (discard

water)

INDOLE ALKALOID

Psilocybin (heat stable)

psilocin

body

Psilocybe Gymnopilus panaeolus

Stimulate (5HT 2 A) receptor

LSD like effect

Clinical ( 0.5-2 h)

Mydriasis Blurred vision Hypotension Tachycardia Euphoria Agitation Hallucination Hyperthermia seizure

treatment

Charcoal Quiet and dark room Diazepam Antipsychotic worsen hyperthermia Or induce seizure)

GI IRRITANT

CHLOROPHYLLUM MOLYBDITES

OMPHALOTUS OLEARIUS

Toxin not isolated Cooking decrease toxicity

Clinical ( 0.5-2 h)

Nausea Vomiting Abdominal pain Bloody diarrhea Bradycardia Diaphoresis Chills dizziness

GI effect + muscarinic like effect without salivation

and lacrimation

treatment

Fluid Electrolyte Ondansetron Charcoal (low effect)

NEPHROTOXIC MUSHROOM

CORTINARIUS

GENTILIS

SPECIO SISSIMUS

ORELLANUS

AMANITA SMITHIANA

TOXIN

Cortinarius: Orellanine (heat stable) Disruption of actin and inhibit protein

synthesis Cortinarin A , cortinarin B A.smithiana: Aminohexadienoic acid

Clinical effect

36h post ingestion! Nausea – vomiting – headache – polydipsia

7-10 day : renal failure (tubulin necrosis)

oliguria - anuria

Treatment

Hemodialysis for a long time is a supportive care ( 50-70 % improve after several weeks)

MUSHROOM WITH DISULFIRAM EFFECT

COPRINUS ATRAMENTARIOUS COPRINE (HEAT STABLE)

AMINOCYCLOPROPANOL

BODY

INHIBIT ALDEHYDE DEHYDROGENASE

If ethanol ingestion within 48 h after mushroom

Flushing-vomiting-tachycardia-arrhythmia

Treatment

Hemodialysis ethanol

acetaldehyde

Fomepizole: inhibit alcohol dehydrogenase

MUSHROOM INDUCE RHABDOMYOLYSIS

RUSSULA SUBNIGRICANS

TRICHOLOMA EQUESTER

CLINICAL

GI effect + myalgia (myoglobinuria) Treatment: Fluid, alkaline urine