Clinical Toxicology II Elective - Mushrooms

Fool's, European destroying angel, death cap, funeral bell, parasol, star and deadly dapperling mushrooms contain...

A) Gyromitrin
B) Muscarine
C) Cyclopeptide
D) Coprine
E) Ibotenic acid and Muscimol
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Fool's, European destroying angel, death cap, funeral bell, parasol, star and deadly dapperling mushrooms contain...

A) Gyromitrin
B) Muscarine
C) Cyclopeptide
D) Coprine
E) Ibotenic acid and Muscimol
C) Cyclopeptide

European destroying angel is found in Fl
False, snow, and hooded false morels contain...

A) Gyromitrin
B) Muscarine
C) Cyclopeptide
D) Coprine
E) Ibotenic acid and Muscimol
A) Gyromitrin
Sweating, jack-o-lantern mushrooms, torn tibrecaps, wooly fiber heads, and white fibercap mushrooms contain...

A) Gyromitrin
B) Muscarine
C) Cyclopeptide
D) Coprine
E) Ibotenic acid and Muscimol
B) Muscarine
Inky caps and shaggy manes contain...

A) Gyromitrin
B) Muscarine
C) Cyclopeptide
D) Coprine
E) Ibotenic acid and Muscimol
D) Coprine
Fly agaric, false blushers, and gemmed amanita contain..

A) Gyromitrin
B) Muscarine
C) Cyclopeptide
D) Coprine
E) Ibotenic acid and Muscimol
E) Ibotenic acid and Muscimol
Wavy, laughing caps, golden tops, and haymakers contain...

A) Psilocybin
B) Orellanine and orelinine
C) Allenic norleucine
D) Erthymelagia acromelic
E) Polyporic acid
A) Psilocybin
Smith's amanita, american abrupt-bulbed lepidella, and Hongo's false death cap contain...

A) Psilocybin
B) Orellanine and orelinine
C) Allenic norleucine
D) Erthymelagia acromelic
E) Polyporic acid
C) Allenic norleucine
Lethal and fools webcaps contain...

A) Psilocybin
B) Orellanine and orelinine
C) Allenic norleucine
D) Erthymelagia acromelic
E) Polyporic acid
B) Orellanine and orelinine
Poison dwarf bamboo mushroom and paralysis funnel contain...

A) Psilocybin
B) Orellanine and orelinine
C) Allenic norleucine
D) Erthymelagia acromelic
E) Polyporic acid
D) Erthymelagia acromelic
Angel wings contain...

A) Psilocybin
B) Orellanine and orelinine
C) Allenic norleucine
D) Erthymelagia acromelic
E) Polyporic acid
E) Polyporic acid
The Man on Horseback and the Yellow Knight can cause... A) Rhabdomyolysis B) Immune mediated hemolytic anemia C) LycoperdonosisA) RhabdomyolysisCommon puffball and the pear-shaped puffball can cause... A) Rhabdomyolysis B) Immune mediated hemolytic anemia C) LycoperdonosisC) LycoperdonosisBrown roll-rim and luric boletes can cause... A) Rhabdomyolysis B) Immune mediated hemolytic anemia C) LycoperdonosisB) Immune mediated hemolytic anemiaAmatoxin is key player in cyclopeptide toxicity. It is most notorious for causing delayed issues with this organ system... A) GI B) Hepatic C) Immunologic D) Neurologic E) RenalB) Hepatic Also causes GI issues as well earlier on, but delayed hepatic issues is the major concern with this substance.What are the key symptomatic indicators of cyclopeptide mushroom ingestion?Delayed GI updated (5-24 hours post ingestion), late hepatic toxicity (2-6 days after). Lab wise, this would manifest as LFT abnormalities and bilirubin and INR increases Generally delayed GI upset is a bad sign, as most other mushrooms are associated with a more immediate GI upset.True or false... If caught fast enough, activated charcoal may be given alongside all poisonous mushrooms to reduce toxicityTrueTrue or false... If caught fast enough, *multi-dose* activated charcoal may be given alongside all poisonous mushrooms to reduce toxicityFalse Not recommended with all of them. Mostly seems to be the ones that have extensive enterohepatic circulationMilk thistle and NAC are considered the antidotes for mushrooms containing this substance. A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolC) Cyclopeptide NAC is really more considered the mainstay of treatment. Milk thistle is recommended at 20-50 mg/kg/day, NAC is recommended at doses used for APAP toxicity (150 mg/kg LD with differing doses after that, but our facilitator typically doses it more aggressively since it's pretty benign).With cyclopeptide containing mushrooms, NAC should be continued until...Coagulopathy and transaminitis has improved.Mushrooms containing this substance may be managed through enhanced elimination techniques such as extracorporeal albumin dialysis, molecular absorbent recirculating systems, and fractionated plasma separation and absorption systems. A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolC) CyclopeptideMushrooms containing this substance are associated with early GI upset, and delayed neurologic issues (dizziness/weakness, seizures, delirium and coma) A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolA) GyromitrinTrue or false... Gyromitrin containing mushrooms inhibit GABA production and thus cause agitation and seizures.True! While BZDs are recommended for initial management, they usually don't work super great because all they do is facillitate GABA action. Typically another anti-seizure medication will be needed to achieve seizure controlPyridoxine and methylene blue are considered the antidotes for mushrooms containing this substance. A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolA) Gyromitrin Pyridoxine (70 mg/kg) is more of the actual antidote. Methylene blue (1-2 mg/kg q4h) is just used to manage methemoglobinemiaMushrooms containing this substance present with the classic cholinergic toxidrome (DUMBELS) A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolB) MuscarineMushrooms containing this substance should be managed with atropine titrated to symptom resolution. A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolB) Muscarine Major thing we're looking for is clear breath soundsMushrooms containing this substance cause a disulfram-like reactions due to aldehyde buildup. A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolD) CoprineWhat is the standard presentation of a patient who consumed coprine containing mushrooms?DISULFRAM REACTION LIKE SYMPTOMS N/V/D, flushing, sweating, hypotension (in some rare cases).How is ingestion of coprine containing mushrooms managed?Supportive care - particularly antiemetics, antihistamines, and activated charcoal if indicated. Fomepizole may have theoretical benefit but there are no studies on humans showing so.Mushrooms containing this substance can cause GABAminergic or glutaminergic manifestations depending on the patients age. A) Gyromitrin B) Muscarine C) Cyclopeptide D) Coprine E) Ibotenic acid and MuscimolE) Ibotenic acid and MuscimolTrue or false... When consuming ibotenic acid and muscimol containing mushrooms children are most likely to experience GABAminergic manifestations (somnolence, hallucinations, delirium) and adults are most likely to experience glutaminergic manifestations (agitations, seizures)False! Other way around! Adults: GABA-ish (somnolent effects) Children: Gluta-ish (excitatory effects)True or false... No antidote exists for ibotenic acid and muscimolTrue! Just managed through ABCs, BZDs, AC if indicatedMushrooms containing this substance produce rapid CNS manifestations (ataxia, hyperkinesia, hallucinations). A) Psilocybin B) Orellanine and orelinine C) Allenic norleucine D) Erthymelagia acromelic E) Polyporic acidA) Psilocybin Structurally similar to 5HT2. Effects usually occur within 4 hours and resolve within 12. No real treatment other than supportive care and BZDs PRN.Mushrooms containing this substance may cause renal issues. A) Psilocybin B) Orellanine and orelinine C) Allenic norleucine D) Erthymelagia acromelic E) Polyporic acid F) B and CF) B and C B) Orellanine and orelinine C) Allenic norleucineRenal replacement therapy, hemoperfusion, hemodialysis, and renal transplant can be considered supportive care options for mushrooms containing this substance. A) Psilocybin B) Orellanine and orelinine C) Allenic norleucine D) Erthymelagia acromelic E) Polyporic acidB) Orellanine and orelinineSpores are most notorious for causing issues with this organ system... A) GI B) Hepatic C) Immunologic D) Neurologic E) RenalC) Immunologic