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Mushroom Poisoning: General Information
With few exceptions, GI symptoms are the first manifestation of mushroom poisoning.
Mushroom Poisoning: If more than 6hours has elapsed between ingestion & onset of symptoms, one should suspect:
Amanita species (cyclopeptide)
Gyromitra species
Cortinarius species
Mushroom Poisoning:
Amanita species
Cyclopeptides: Amanita phalloides is similar to acetaminophen poisoning, & produces a centrilobular necrosis of the liver. The amatoxin is heat-stabile, & is taken up by hepatocytes & inhibits mRNA synthesis, leading to acute hepatitis & fulminant liver failure.
Mushroom Poisoning:
Gyromitra species
Gyromitra species (monomethylhydrazine) causes seizures, methemoglobinemia & hemolytic anemia. It is similar to isoniazid in inhibiting the enzyme pyridoxine phosphokinase that converts pyridoxine to otrudixak 5' phosphate. Both poisoning by monomethylhydrazine and INH require the antidote pyridoxine.
Mushroom Poisoning:
Cortinarius species
Cortinarius species (orelline & orellanine) produce renal failure.
Mushroom Poisoning:
Stages of Clinical Presentation with Cyclopeptides (Amanita phalloides) poisoning
Stage 1 (6-24 hrs): vomiting, diarrhea, abdominal pain, dehydration, tachycardia, hypotension & hyperglycemia

Stage 2(24-48 hours): symptoms improve, but worsening hepatitis & azotemia demonstrated by labs.

Stage 3(3-5 days): fulminant hepatic failure, hepatic encephalopathy, coma & death