Amanita phalloides (death cap) A. verna A.virosa Galerina marginata.
-
Upload
marcus-lane -
Category
Documents
-
view
233 -
download
4
Transcript of Amanita phalloides (death cap) A. verna A.virosa Galerina marginata.
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