amanita phalloides (death cap) a. verna a.virosa galerina marginata
TRANSCRIPT
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MUSHROOMS
5000 SPECIES (2%)
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Cyclopeptide Toxin
Amanita phalloides (death cap) A. verna A.virosa
Galerina marginata
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1-Amatoxins› Α-amanitin › β-amanitin
2-Phallotoxin› Phalloidin
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Amatoxin:high oral absorb, entrohepatic
circulation, renal reabsorptionPhallotoxin:very low oral absorption (no oral
toxicity)Both: heat stable
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Amatoxin
Inhibit RNA polymerase ║ Interfere DNA Transcription
Protein Synthesis Necrosis
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Amatoxin target
Liver KIDNEY
PANCREAS
INTESTINE
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phallotoxin
Bind to actin Disrupt cell membrane liver protein synthesis
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Clinical
1-- GI effect (6-24h)› Abdominal pain› nausea› vomiting› Diarrhea› Fever› Hypoglycemia› elecrolyte imbalance
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CLINICAL
2- Temporary clinical remission (24-72h)
Toxin induce cell injury (misdiagnose)
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CLINICAL
3--Hepatorenal phase (3-6 days)› Hepatic-renal failure› Pancreatitis› Coagulophaty› Seizure› Coma
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Treatment
Lavage Charcoal Diuresis Electrolyte balance Vit K FFP Glucose
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Penicillin G
300,000-One million IU/Kg (seizure)
Displace toxin from protein binding renal excretion
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Silymarin
140 mg TID Inhibit toxin uptake by cells NAC– thioctic acid– hyperbaric(oxygen) regenerate Hemodialysis- hemopefusion
late
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Gyromitrin toxin (heat labile)
Gyromitra esculenta gyromitrin GI methyl formyl hydrazine GI
Methyl
Hydrazine
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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
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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
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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
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MUSCARINE Heat stable Low oral absorbtion Clitocybe Inocybe No effect on nicotinic receptor No CNS effect
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CLINICAL (0.5 – 1h)
Cholinergic: › salivation › lacrimation› Diarrhea› Bradycardia› Hypotension› perspiration
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Treatment
Lavage Charcoal Ipratropium (inhalation) Atropine Glycopyrolate (0.5 to 1 mg ) IV No CNS effect
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AMANITA MUSCARIAAND
AMANITA PANTHERINA
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ISOXAZOLE COMPOUND
Ibotenic acid NMDA activation excitation
muscimol GABA agonist depression
serotonin , dopamine
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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
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Treatment
Charcoal Quiet, dark room Diazepam in agitation No role for atropine Poison exctract by water (discard
water)
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INDOLE ALKALOID
Psilocybin (heat stable)
psilocin
body
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Psilocybe Gymnopilus panaeolus
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Stimulate (5HT 2 A) receptor
LSD like effect
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Clinical ( 0.5-2 h)
Mydriasis Blurred vision Hypotension Tachycardia Euphoria Agitation Hallucination Hyperthermia seizure
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treatment
Charcoal Quiet and dark room Diazepam Antipsychotic worsen hyperthermia Or induce seizure)
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GI IRRITANT
CHLOROPHYLLUM MOLYBDITES
OMPHALOTUS OLEARIUS
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Toxin not isolated Cooking decrease toxicity
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Clinical ( 0.5-2 h)
Nausea Vomiting Abdominal pain Bloody diarrhea Bradycardia Diaphoresis Chills dizziness
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GI effect + muscarinic like effect without salivation
and lacrimation
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treatment
Fluid Electrolyte Ondansetron Charcoal (low effect)
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NEPHROTOXIC MUSHROOM
CORTINARIUS
GENTILIS
SPECIO SISSIMUS
ORELLANUS
AMANITA SMITHIANA
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TOXIN
Cortinarius: Orellanine (heat stable) Disruption of actin and inhibit protein
synthesis Cortinarin A , cortinarin B A.smithiana: Aminohexadienoic acid
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Clinical effect
36h post ingestion! Nausea – vomiting – headache – polydipsia
7-10 day : renal failure (tubulin necrosis)
oliguria - anuria
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Treatment
Hemodialysis for a long time is a supportive care ( 50-70 % improve after several weeks)
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MUSHROOM WITH DISULFIRAM EFFECT
COPRINUS ATRAMENTARIOUS COPRINE (HEAT STABLE)
AMINOCYCLOPROPANOL
BODY
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INHIBIT ALDEHYDE DEHYDROGENASE
If ethanol ingestion within 48 h after mushroom
Flushing-vomiting-tachycardia-arrhythmia
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Treatment
Hemodialysis ethanol
acetaldehyde
Fomepizole: inhibit alcohol dehydrogenase
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MUSHROOM INDUCE RHABDOMYOLYSIS
RUSSULA SUBNIGRICANS
TRICHOLOMA EQUESTER
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CLINICAL
GI effect + myalgia (myoglobinuria) Treatment: Fluid, alkaline urine
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