Mushroom poisoning is an acute intoxication that occurs when in contact with poisons that are contained in fruit bodies. Symptoms vary depending on the type of fungus. The most common signs are vomiting, diarrhea, abdominal pain, jaundice, seizures, decreased blood pressure, impaired consciousness. Pathology is diagnosed according to anamnesis, results of chemical and toxicological examination of blood, urine. First aid includes the removal of poison from the body by gastric lavage, enterosorbents. Planned therapy is carried out using antidotes, extracorporeal detoxification procedures, hepatoprotective and antitoxic drugs.
T62.0 Toxic effect of other toxic substances contained in eaten foods. In the eaten mushrooms.
There are about 50 varieties of mushrooms known to have toxic properties. The most dangerous are considered to be fly agaric and pale toadstool. More than 1,000 episodes of lesion are registered annually on the territory of the USA, the mortality rate varies between 10-40%. About 90% of the dead ate the mushroom Amanita phalloides, whose toxins have hepatotoxic and cytolytic effects. 83% of cases occur at the end of July — the end of October, which corresponds to the growing season of the plant. In addition to USA, mushroom poisoning is common in the Canada, Sweden, Poland, Bulgaria, Ukraine, Belarus and other countries where this product is considered traditional. The risk group consists of children, urban residents who do not have sufficient knowledge about the types of mushrooms.
The main cause of pathology is mediocre identification skills of plant varieties. The share of poisoning provoked by poor knowledge of the mushroom picker accounts for 95% of cases. As a rule, a toxic product that looks like an edible variety is eaten: lines, false chanterelles, honeydew, buttermilk. Less often, symptoms of intoxication occur in people who have confused a white mushroom with a bilious or satanic one. Mushroom poisoning can develop for other reasons:
- Errors in cooking. Some types of plants (blackheads, white bunches) contain caustic milky juice that irritates the tissues of the digestive tract. To eliminate it, the product is soaked for several hours. When eating insufficiently processed fruit bodies, signs of gastroenteritis occur.
- Using Psilocybe for anesthesia. Mushrooms of this variety have hallucinogenic and psychostimulating effects. They are actively used by drug addicts, as well as representatives of individual sects to achieve an altered state of consciousness, putting a person into a trance. The therapeutic range is quite narrow, when going beyond the permissible limits, central nervous system depression, coma, death develops.
- The presence of third-party toxicants. Fruit bodies growing near chemical enterprises and organizations whose activities are associated with the use of heavy metals can accumulate toxic substances. Plants collected along highways are considered slightly less dangerous, however, they can also provoke symptoms of exotoxicosis.
- Joint use with alcohol. Certain types (ink dung), when taken simultaneously with alcohol, lead to the formation of a disulfiram-like effect. Ethanol processing is interrupted at the acetaldehyde stage. The victim has symptoms of poisoning: vomiting, redness of the face, difficulty breathing, tachycardia.
Pathogenetic processes differ in the type of fungi that caused intoxication. Poisons of the amanite group of plants (pale toadstool, fly agaric) destroy hepatocyte membranes, inhibit oxidative phosphorylation in mitochondria, interrupt protein synthesis. The most sensitive to the damaging effects are liver cells, kidneys, lymphocytes, enterocytes. After the use of Gyromitra (lines, morels), erythrocyte hemolysis occurs, followed by the development of hemoglobinuria nephrosis. The liver reacts to the effects of the toxin by forming small necrotic foci.
The genera of Clitocybe, Paxillus and Inocybe (talkers, pigs, fibroids) provoke immunoallergic reactions accompanied by the destruction of red blood cells, cause nephropathy, hepatopathy, gastroenteritis. Symptoms are more pronounced with repeated use of mushrooms, which is due to the cumulative effect of the toxicant. Psilocybe lead to the occurrence of mycoatropin and psychodisleptic syndrome, impaired conduction of the nerve impulse. Entoloma is poisonous, ryadovka is red, red-haired champignon have an irritating effect.
Mushroom poisoning is divided by reasons (errors in collection and preparation, narcotic purpose, joint reception with strong drinks); leading syndrome (phalloidin, gyromitrovy, mycoatropin and others); type of product (fly agaric, pale toadstool, stitches, fiber). The main classification is considered to be poisoning by severity:
- Easy. Signs of pathology are expressed moderately, depression of consciousness and breathing, other vital disorders are not determined. Against the background of taking psilocybin varieties, visual and auditory hallucinations are possible. Hospitalization is not required, the existing clinical manifestations pass independently after 1-3 days.
- Medium. Moderate depression of consciousness, the picture is expanded. The predominance of one or another syndrome is clearly traced (depends on the variety of mushroom). With timely first aid, the risks to life are low, the exception is pale toadstool, fly agaric. Hospitalization in a toxicological hospital is required.
- Heavy. There is a sopor or coma, the vital functions of the body are suppressed. The patient is non-contact or inadequate, is in an altered state of consciousness (Psilocybe). Emergency transportation to the nearest intensive care unit is shown. Before it begins, first aid must be provided, continuous monitoring of the main vital indicators must be established.
The signs of exotoxicosis differ directly depending on the type of fungus. After eating red fly agaric, spider web or fiber, the victim develops vomiting, nausea, abdominal pain. These symptoms are determined 1-2 hours after the receipt of the poison. Then there is hypersalivation, constriction of the pupils, violation of respiratory activity according to the central type. There may be a failure of the heart rhythm, convulsions. In severe cases, loss of consciousness occurs, breathing becomes frequent, shallow.
If the toxicant is a pale toadstool, a false toadstool, the patient complains of sharp cramping abdominal pain, indomitable vomiting, thirst, cholera-like diarrhea with an admixture of blood. Convulsions begin with the calf muscles and jaws, and later become generalized. Mushroom poisoning of this type manifests itself after 6-48 hours. Toxic hepatitis is diagnosed after 2 days. The skin turns yellow, vascular asterisks are formed. On palpation, the liver is enlarged, protruding beyond the edge of the costal arch.
Signs of damage by poisons of stitches and morels are mainly due to their ability to affect the functioning of the kidneys, which leads to changes in hemodynamics and water-electrolyte balance. There are arrhythmias, bradycardia, a decrease in blood pressure. The toxic effect on the central nervous system is manifested by psychomotor agitation, euphoria, confusion. Vascular collapse is possible, which is weakly amenable to relief with the usual medications.
Ink dung is considered a conditionally edible mushroom, but it contains coprin, a substance that blocks aldehyde dehydrogenase. If the amount of this enzyme in the body becomes insufficient, a person loses the ability to process ethyl alcohol. Metabolites of the latter, accumulating in the blood, cause hot flashes, sweating, tremor, chest pain, tachycardia, hypersalivation, diarrhea. When taking a significant dose of alcohol, the death of the victim from acute cardiovascular insufficiency is possible.
There are a number of different fungi with similar effects. These include ryadovka and entoloma poisonous, gall mushroom, false raincoat, pink wave, common milkweed. The juice of these plants has an irritating effect, causes acute gastroenteritis: diarrhea, pain around the navel of a cramping or stabbing nature, vomiting, nausea, bloating, general toxic syndrome (hyperthermia, headache, general deterioration of well-being).
Mushroom poisoning leads to complications in 45-50% of patients. The most common consequence of intoxication is the formation of multiple organ failure with damage to the hepatobiliary, urinary and cardiovascular systems. The patient has anuria, coagulation disorder, internal bleeding, endotoxicosis associated with the accumulation of toxic metabolites. The cascade of pathological changes is rapidly increasing, encephalopathy joins, significant electrolyte failures. MOF is the main cause of death of the victims.
Liver damage is accompanied by a coma in 25-30% of people. This phenomenon is considered a prognostically unfavorable sign. Against the background of changes in the hepatic parenchyma, the patient develops disseminated intravascular coagulation syndrome. Clinically, it is manifested by bleeding gums, the appearance of petechial rash, hemorrhages in the sclera, when internal hemorrhages occur — a decrease in blood pressure, tachycardia, pallor of the skin.
Mushroom poisoning requires immediate first aid, so the diagnosis is made at the pre-hospital stage based on the results of anamnesis collection. The task falls on the ambulance doctor who arrived to the victim. A full-fledged examination is performed in a hospital by a toxicologist or an anesthesiologist-resuscitator. It is necessary to differentiate pathology from damage by psychodisleptics, neurotropic drugs, drugs, as well as from manifestations of food toxicoinfection. The following diagnostic methods are used:
- Physical. The main clinical signs of poisoning by a particular group of plants are determined. The skin is of normal color or pale, with diarrhea — dry, dehydrated. Tachycardia is determined, blood pressure is higher than 140/90 or 20-40 mm Hg lower than usual. There may be mental excitement, an inadequate assessment of what is happening.
- Laboratory. A toxicochemical examination allows you to detect the presence of poison in the blood or urine. With diarrhea, an increase in hematocrit occurs, a violation of hepatic function is accompanied by an increase in bilirubin to 30 mmol / l and higher. Fecal masses contain hidden or scarlet blood. Metabolic acidosis is present, the concentration of gamma-glutamyltranspeptidase increases.
- Hardware. They are used in the provision of resuscitation care. They consist in the use of an anesthesiological monitor to monitor vital signs: blood pressure, heart rate, saturation, body temperature. These figures can vary very widely, their values depend on the characteristics of the influence of the toxicant, the stage of the disease, the patient’s reaction to the poisoning effect.
First aid for mushroom intoxication is provided to the victim on the spot. Then medical evacuation is carried out. All measures are aimed at the speedy removal of the toxic substance from the body, correction of emerging disorders, maintenance of vital functions. Before the arrival of doctors, the patient should be provided with rest, an influx of fresh air. If consciousness is preserved, non-probe gastric lavage is allowed. In case of coma, the patient should be put on his side, to ensure pulse control.
It consists of non-specific therapeutic measures. The stomach must be rinsed with water, about 7-10 liters are required for one procedure. The criterion for the success of the procedure is the appearance of a clean washing liquid. Manipulation is carried out through a thick gastric tube. After its completion, the victim is given activated charcoal or another sorbent in a therapeutic dose. Comatose states require the administration of proserin or pilocarpine. The risk of liver damage can be reduced by prescribing silymarin.
Mushroom poisoning is an indication for complex antitoxic measures. The victim is undergoing forced diuresis with an intravenous infusion of 10-12 liters of crystalloids and subsequent stimulation of urination. Saline laxatives are used (magnesium sulfate inside or intestinal lavage). If necessary, extracorporeal methods of removing toxins are prescribed — hemodialysis, hemosorption. It requires the introduction of antidotes — milk thistle extract, vitamins B1, B6, B12.
Correction of electrolyte disturbances is carried out under the control of the ABB. Saline infusion solutions, sodium bicarbonate as a buffer agent are used. It is recommended to include hepatoprotectors in the scheme. The antidote to amanite-containing mushrooms (toadstool, fly agaric) is succinic acid. Heparin is used to prevent coagulatory disorders. After the removal of the poison, it is possible to introduce drugs that weaken intestinal motility in order to stop diarrhea. Vomiting is eliminated with the help of dopamine receptor antagonists.
The recovery time for mushroom poisoning varies, with mild degrees is 3-7 days, with moderate — 10-14 days. Severe lesions with natural poisons require hospital stay for 21-28 days, and against the background of complications — up to 50 days. After discharge, the patient is recommended to be monitored by a therapist or gastroenterologist at the place of residence, restriction of physical activity for up to 3-6 months, compliance with a sparing diet.
Prognosis and prevention
Signs of intoxication of the initial degrees do not pose a threat to life. The prognosis is favorable if first aid is implemented within a few hours after the onset of symptoms. Severe poisoning, accompanied by multiple organ failure, DIC syndrome, encephalopathy, are prognostically unfavorable. Mortality reaches 40% with rapid hospitalization, 80-95% in the absence of medical benefits. The probability of a successful outcome increases if the treatment is carried out in a specialized toxicological clinic.
Prevention includes a thorough study of the signs that distinguish a poisonous product from an edible one. If there is no confident knowledge, the collection must be abandoned. Cooking should be done in strict accordance with the recipe. You should not independently exclude certain stages of preliminary culinary processing of the plant. If there are signs of intestinal damage shortly after eating, it is necessary to immediately call the ambulance team. Before her arrival, you need to provoke vomiting, remove the contents of the stomach, this will reduce the severity of poisoning.