What is the treatment for wild mushroom poisoning?

From the Guidelines

Treatment for wild mushroom poisoning requires immediate medical attention, and the most effective approach includes administration of penicillin G and silibinin, as well as supportive care with IV fluids and medications to control symptoms. If you suspect mushroom poisoning, call poison control or go to an emergency room right away. Initial treatment typically involves activated charcoal to prevent further toxin absorption if the ingestion was recent. Supportive care includes IV fluids to maintain hydration and electrolyte balance, and medications to control symptoms like nausea and vomiting (ondansetron 4-8mg IV) 1. For Amanita phalloides poisoning, specific treatments may include high-dose penicillin G (300,000-1 million units/kg/day) and silibinin (20-50mg/kg/day) if available, as recommended by the American Association for the Study of Liver Diseases (AASLD) 1.

Some key points to consider in the treatment of wild mushroom poisoning include:

• Prompt medical attention is essential to improve outcomes
• Activated charcoal may be used to prevent further toxin absorption
• Supportive care with IV fluids and medications to control symptoms is crucial
• Penicillin G and silibinin may be effective in treating Amanita phalloides poisoning, although their efficacy has not been proven in controlled trials 1
• Liver function monitoring and possibly liver transplantation may be required in severe cases, as recommended by the AASLD 1

It is also important to note that the effectiveness of treatment depends on the type of mushroom consumed, amount ingested, and how quickly treatment begins. Different mushroom toxins work through various mechanisms, which is why prompt, specialized medical care is essential.

From the FDA Drug Label

Antidote for organophosphorus or muscarinic mushroom poisoning: Initial single dose of 2 to 3 mg, repeated every 20 to 30 minutes. ( 2) The treatment for wild mushroom poisoning with atropine is an initial single dose of 2 to 3 mg, repeated every 20 to 30 minutes 2.

• Key points:
  • Dosage: 2 to 3 mg
  • Administration: Intravenous
  • Frequency: Every 20 to 30 minutes
• Important consideration: This treatment is specifically for muscarinic mushroom poisoning.

From the Research

Treatment Overview

The treatment for wild mushroom poisoning, particularly due to the Amanita genus, involves a combination of supportive care, medical therapy, and in severe cases, liver transplantation.

• Supportive care includes fluid and electrolyte replacement, oral activated charcoal, and lactulose to help manage symptoms and prevent further absorption of the toxin.
• Medical therapy may involve the use of penicillin G, silymarin (also known as silibinin), and N-acetylcysteine to support liver function and aid in the elimination of the toxin 3, 4, 5.
• In cases of severe poisoning, where patients develop fulminant liver failure, urgent liver transplantation may be necessary as a life-saving measure 6, 5.

Specific Treatment Modalities

• Intensive hemodialysis and hemoperfusion have been used in the treatment of Amanita mushroom poisoning, with the aim of accelerating the elimination of amatoxin from the body. However, the effectiveness of these methods has been debated, with some studies suggesting they may not significantly contribute to the clearance of amatoxin 4, 7.
• Silibinin and N-acetylcysteine are considered part of the medical therapy for amatoxin intoxication, based on small case series, although randomized controlled trials are lacking 5.
• The use of albumin dialysis (molecular absorbent recycling system, MARS) has been reported as a potentially useful support system in the treatment of patients with severe liver failure due to mushroom poisoning 3.

Clinical Considerations

• Early recognition of the clinical syndrome of mushroom poisoning is crucial, as the initial symptoms can be nonspecific and similar to those of common gastroenteritis.
• The severity of poisoning can vary, and treatment should be tailored to the individual patient's condition, with close monitoring for signs of liver and renal failure.
• In severe cases, prompt referral to a liver transplantation center may be necessary to ensure the best possible outcome 6, 5.