A week ago, while running a busy clinic as usual, I got a call about an emergency in the accident and emergency unit that needs my attention. I immediately dropped everything and ran to the accidents and emergency unit. On my arrival I find a gentleman in his early 50s writhing with abdominal pains, sweating profusely and vomiting. I enquire what is wrong, and he tells me he consumed some wild mushrooms.
Mushroom poisoning occurs after the ingestion of mushrooms that contain toxins. This is usually from mushrooms that are picked in the wild by inexperienced persons. It is often very difficult to differentiate between edible and poisonous mushrooms, particularly to a novice. The symptoms of poisoning vary greatly depending on the type and the quantity of mushroom consumed, from mild symptoms to even death.
In most cases the symptoms are caused by irritation of the stomach and intestines. The symptoms usually appear within 20 minutes to up to 4 hours. The common symptoms are nausea, vomiting, abdominal cramps, and diarrhoea. Usually, these symptoms resolve after the vomiting. However, in some instances the symptoms are so severe that they require hospitalization.
There is a certain species of mushrooms that particularly affects the nervous system. This would lead to profuse sweating, salivation, tearing, diarrhoea, vomiting. They may be irregular heartbeat and difficulty in breathing. In some patients they may be confusion, vision disturbances, drowsiness and seizures. Often this type of poisoning needs medical attention to provide certain medications to reverse these symptoms.
There is one species of mushrooms called amanita phalloides which is extremely toxic. Its mortality rate has been reported to be up to 50% and probably higher in low-income countries with poor health care systems. It is particularly dangerous because often the symptoms are delayed for 6 to up to 24 hours, by then the toxins are already absorbed into the blood stream and can’t be removed from the stomach.
The toxins can cause liver and kidney damage and initially the patient will have no symptoms. At a later stage they may present with bloody diarrhoea, vomiting and severe abdominal pains. Their blood work will show kidney and liver failure. This may be associated with blood clotting abnormalities. The management of this can be complicated and includes aggressive intravenous fluids and supportive treatment for the liver and kidney failure.
The spectrum of presentation for mushroom poisoning is very wide and cannot be comprehensively covered in a short column. The take home message should be to avoid consumption of wild mushrooms especially when there is little knowledge in identifying the edible ones. If one has symptoms, it is important to present to a healthcare facility, no matter how trivial the symptoms may seem. Early presentation saves lives, which is probably what saved my patient from last. I happily discharged him home with no symptoms or long-lasting effects from his episode of mushroom poisoning.
