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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvODE3ODQ4LXdvcmt1cA==\nDrugs & Diseases > Emergency Medicine\nHallucinogenic Mushroom Toxicity Workup\nAuthor: Louis Rolston-Cregler, MD; Chief Editor: Sage W Wiener, MD more...\nHallucinogenic Mushroom Toxicity\nSections Hallucinogenic Mushroom Toxicity\nIdentification of Mushroom Specimens\nPharmacologic Therapy\nGI decontaminants\nNo particular diagnostic procedures are available or needed for most patients with toxicity from mushrooms containing muscimol or ibotenic acid.\nLaboratory studies can be helpful in identifying complications of hallucinogenic mushroom abuse, which may include hepatotoxicity with repeated use, acute renal failure, and rhabdomyolysis. [31] Serum levels and urine tests for toxins such as muscarine, muscimol, and psilocybin are available but are rarely helpful or necessary in clinical practice. [32] They are more applicable to forensic investigations.\nIdentification of the mushroom by a mycologist is desirable. Gastric contents may be examined. A mycologist may be able to microscopically identify the spores recovered from the patient’s gastric contents.\nA complete blood count (CBC) should be obtained because some mushroom toxins (eg, gyromitrin) can cause hemolytic anemia.\nBaseline liver function studies are indicated because possible ingestion of other toxic mushrooms (eg, those containing cyclopeptides) can cause hepatotoxicity.\nBaseline renal function studies are indicated because some mushrooms are nephrotoxic, such as A smithiana and orelline mushrooms.\nEvaluation for rhabdomyolysis should be considered if signs and symptoms warrant because some mushrooms (eg, Tricholoma equestre) may cause muscle toxicity.\nA basic serum metabolic profile (sodium, potassium, chlorine, carbon dioxide, creatinine, glucose, and calcium) should be obtained to evaluate for fluid and electrolyte disturbances due to other offending ingestants.\nUrine drug screening should be considered, especially if the patient has unexplained symptoms or behavioral changes, if suicidal intent, substance abuse or foul play is suspected, or if ingestion of unknown toxins is suspected. The patient’s urine may be analyzed for muscimol to confirm muscimol poisoning, but this test is not typically available in hospital laboratories.\nIdentification of the mushroom ingested is generally desirable. However, with hallucinogenic mushrooms, definitive identification is seldom necessary. Exact identification of the mushroom is achieved in fewer than 3% of cases.\nMushrooms in the ibotenic acid group (see the images below) are commonly found throughout the United States, Europe, and Asia. They are found in wooded areas, especially among conifer forests, in the spring and fall seasons of North America. The young specimens emerge with patches of membrane left covering the cap and forming a cup (volva) at the base. The mature specimens often have brilliant cap colors and delicate skirts and cups.\nFly agaric (Amanita muscaria).\nAmanita muscaria.\nAmanita muscaria var. guessowii with yellow cap surface, from Massachusetts.\nAmanita muscaria var. formosa sensu Thiers, from Oregon.\nAmanita pantherina.\nA muscaria can occur alone or in groups on the ground of forests, in grassy areas and lawns, and especially under trees. The cap is 5-30 cm in diameter and contains white warts. The stalk is white, frequently hollow, and often as long as 15-20 cm. A prominent volva is found at the bottom of the stalk, with numerous rings superiorly. The gills are free and white. The spores are also white. The appearance varies according to geographic location. Scarlet caps are most common in western North America, orange to yellow-orange caps in eastern North America.\nDifferent types of mushrooms can be found in the same location, and reliance on a single sample can lead to false identification of the mushroom that was ingested. All mushrooms in the immediate vicinity of the ingestion site must be considered. When no specimen is brought in by a patient with a suspected mushroom ingestion, sending an experienced forager to the site to collect any mushrooms growing in the area might be helpful.\nWhen mushroom specimens are obtained for identification, the entire mushroom should be dug up to preserve the architecture of the bulb, stem, and cap. (Keep in mind, however, that definitive identification should be made by an experienced mycologist rather than by a physician.)\nTo make a spore print, slice the mushroom stem from the cap very close to the gills, and lay the cap onto a piece of paper with the gills down. Make prints on black-and-white paper. These can be sent to the regional poison control center or its designee for analysis.\nWhole mushrooms can be sent. Samples should include, if possible, the deeply rooted portion of the fungus, as well as the cap and gills. They should not be packaged in plastic or cloth, because they may decompose rapidly. Samples should be placed in a paper bag with an absorbant (eg, a piece of filter paper) to prevent condensation. Transporting the mushrooms in this way minimizes destruction of their natural architecture, discoloration of the cap or gills, and premature release of the spores. The mushrooms also must not be refrigerated or crushed.\nThe widespread availability of digital cameras enables rapid transmission of images of mushroom samples to mycologists over the Internet. Although it may not be possible to make a definitive identification via this method, it may be possible at least to rule out certain species. [26]\nChromatographic techniques (eg, thin-layer chromatography [TLC], gas-liquid chromatography [GLC], and high-pressure liquid chromatography [HPLC]) are available to detect ibotenic acid, muscimol, [33] and psilocybin, as well as other mushroom toxins (eg, amanitins, orellanine, muscarine, and gyromitrins). However, these techniques are typically unavailable to general practitioners, being largely restricted to laboratories conducting research on these compounds.\nIf the diagnosis is uncertain, and if blunt head trauma is part of the differential diagnosis because of changes in mental status, plain computed tomography (CT) of the head is warranted before lumbar puncture is performed.\nMcDonald A. Mushrooms and madness. Hallucinogenic mushrooms and some psychopharmacological implications. Can J Psychiatry. 1980 Nov. 25(7):586-94. [Medline].\nClilton WS. The chemistry and mode of action of mushroom toxins. Spoerke DG, Rumack BH, eds. Handbook of Mushroom Poisoning. 2nd ed. CRC Press, LLC; 1994. 165-223.\nReynaud-Maurupt C, Cadet-Taïrou A, Zoll A. The contemporary uses of hallucinogenic plants and mushrooms: a qualitative exploratory study carried out in France. Subst Use Misuse. 2009. 44(11):1519-52. [Medline].\nMcPartland JM, Vilgalys RJ, Cubeta MA. Mushroom poisoning. Am Fam Physician. 1997 Apr. 55(5):1797-800, 1805-9, 1811-2. [Medline].\nMichelot D, Melendez-Howell LM. Amanita muscaria: chemistry, biology, toxicology, and ethnomycology. Mycol Res. 2003 Feb. 107:131-46. [Medline].\nSchwartz RH, Smith DE. Hallucinogenic mushrooms. Clin Pediatr (Phila). 1988 Feb. 27(2):70-3. [Medline].\nEaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J, et al. Youth risk behavior surveillance - United States, 2009. MMWR Surveill Summ. 2010 Jun 4. 59(5):1-142. [Medline].\nMowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 33rd Annual Report. Clin Toxicol (Phila). 2016 Dec. 54 (10):924-1109. [Medline]. [Full Text].\nRimsza ME, Moses KS. Substance abuse on the college campus. Pediatr Clin North Am. 2005 Feb. 52(1):307-19, xii. [Medline].\nHallock RM, Dean A, Knecht ZA, Spencer J, Taverna EC. A survey of hallucinogenic mushroom use, factors related to usage, and perceptions of use among college students. Drug Alcohol Depend. 2013 Jun 1. 130(1-3):245-8. [Medline].\nPellegrini M, Rotolo MC, Marchei E, Pacifici R, Saggio F, Pichini S. Magic truffles or Philosopher's stones: a legal way to sell psilocybin?. Drug Test Anal. 2013 Mar. 5(3):182-5. [Medline].\nBenjamin DR. Mushroom poisoning in infants and children: the Amanita pantherina/muscaria group. J Toxicol Clin Toxicol. 1992. 30(1):13-22. [Medline].\nPoisindex managements, mushrooms - muscimol / ibotenic acid. In: Poisindex System [Internet database online] [database online]. Greenwood Village (CO): Thomson Reuters (Healthcare). May 17, 2011;\nMrazova K, Navratil T, Pelclova D. Use and accidental exposure to hallucinogenic agents reported to the Czech Toxicological Information Centre from 1995 to 2008. Subst Use Misuse. 2011. 46(4):460-5. [Medline].\nWatson WA, Litovitz TL, Rodgers GC Jr, Klein-Schwartz W, Reid N, Youniss J, et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2005 Sep. 23(5):589-666. [Medline]. [Full Text].\nBrvar M, Mozina M, Bunc M. Prolonged psychosis after Amanita muscaria ingestion. Wien Klin Wochenschr. 2006 May. 118(9-10):294-7. [Medline].\nSatora L, Pach D, Butryn B, Hydzik P, Balicka-Slusarczyk B. Fly agaric (Amanita muscaria) poisoning, case report and review. Toxicon. 2005 Jun 1. 45(7):941-3. [Medline].\nSatora L, Pach D, Ciszowski K, Winnik L. Panther cap Amanita pantherina poisoning case report and review. Toxicon. 2006 Apr. 47(5):605-7. [Medline].\nMichael W. Beug. 2014 NAMA Toxicology Committee Report North American Mushroom Poisonings. North American Mycological Association. Available at http://www.namyco.org/2014_nama_toxicology_committee.php. 2014; Accessed: January 29, 2017.\nDiaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med. 2005 Feb. 33(2):419-26. [Medline].\nDiaz JH. Syndromic diagnosis and management of confirmed mushroom poisonings. Crit Care Med. 2005 Feb. 33(2):427-36. [Medline].\nBerger KJ, Guss DA. Mycotoxins revisited: Part I. J Emerg Med. 2005 Jan. 28(1):53-62. [Medline].\nGoldfrank LR. Mushrooms. Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE. Goldfrank’s Toxicologic Emergencies. 9th ed. New York: McGraw-Hill; 2011. 1522-36.\nWest PL, Lindgren J, Horowitz BZ. Amanita smithiana mushroom ingestion: a case of delayed renal failure and literature review. J Med Toxicol. 2009 Mar. 5(1):32-8. [Medline].\nFischbein CB, Mueller GM, Leacock PR, Wahl MS, Aks SE. Digital imaging: a promising tool for mushroom identification. Acad Emerg Med. 2003 Jul. 10(7):808-11. [Medline].\nMiller OK. Mushrooms of North America. Dutton; 1982. 368.\nCarter OL, Pettigrew JD, Burr DC, Alais D, Hasler F, Vollenweider FX. Psilocybin impairs high-level but not low-level motion perception. Neuroreport. 2004 Aug 26. 15(12):1947-51. [Medline].\nBorowiak KS, Ciechanowski K, Waloszczyk P. Psilocybin mushroom (Psilocybe semilanceata) intoxication with myocardial infarction. J Toxicol Clin Toxicol. 1998. 36(1-2):47-9. [Medline].\nBickel M, Ditting T, Watz H, Roesler A, Weidauer S, Jacobi V, et al. Severe rhabdomyolysis, acute renal failure and posterior encephalopathy after 'magic mushroom' abuse. Eur J Emerg Med. 2005 Dec. 12(6):306-8. [Medline].\nRaff E, Halloran PF, Kjellstrand CM. Renal failure after eating \"magic\" mushrooms. CMAJ. 1992 Nov 1. 147(9):1339-41. [Medline]. [Full Text].\nSticht G, Käferstein H. Detection of psilocin in body fluids. Forensic Sci Int. 2000 Sep 11. 113(1-3):403-7. [Medline].\nStríbrný J, Sokol M, Merová B, Ondra P. GC/MS determination of ibotenic acid and muscimol in the urine of patients intoxicated with Amanita pantherina. Int J Legal Med. 2012 Jul. 126(4):519-24. [Medline].\nGoldfrank L, Flomenbaum N, Lewin N. Goldfrank’s Toxicologic Emergencies. 4th ed. Appleton & Lange; 1990. 575-85.\nBeuhler MC, Sasser HC, Watson WA. The outcome of North American pediatric unintentional mushroom ingestions with various decontamination treatments: an analysis of 14 years of TESS data. Toxicon. 2009 Mar 15. 53(4):437-43. [Medline].\n[Guideline] Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila). 2005. 43(2):61-87. [Medline]. [Full Text].\nLouis Rolston-Cregler, MD Resident Physician, Department of Emergency Medicine, SUNY Downstate Medical Center, Kings County Hospital Center\nLouis Rolston-Cregler, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association, Student National Medical Association\nSage W Wiener, MD Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Director of Medical Toxicology, Department of Emergency Medicine, Kings County Hospital Center\nSage W Wiener, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, Society for Academic Emergency Medicine\nWilliam Banner Jr, MD, PhD Medical Director, Oklahoma Poison Control Center; Clinical Professor of Pharmacy, Oklahoma University College of Pharmacy-Tulsa; Adjunct Clinical Professor of Pediatrics, Oklahoma State University College of Osteopathic Medicine\nWilliam Banner Jr, MD, PhD, is a member of the following medical societies: American College of Medical Toxicology\nPeter A Chyka, PharmD, FAACT, DABAT Professor and Executive Associate Dean, College of Pharmacy, University of Tennessee Health Science Center\nPeter A Chyka, PharmD, FAACT, DABAT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Clinical Pharmacy, and American Society of Health-System Pharmacists\nTimothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin\nTimothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society\nMiguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio\nMiguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association\nDiane F Giorgi, MD, FACEP Attending Physician, Department of Emergency Medicine, Brooklyn Hospital Center\nDiane F Giorgi, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American Association of Women Emergency Physicians, American College of Emergency Physicians, and American College of Physicians\nMichael Hodgman, MD Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare\nMichael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society\nC Crawford Mechem, MD, MS, FACEP Professor, Department of Emergency Medicine, University of Pennsylvania School of Medicine; Emergency Medical Services Medical Director, Philadelphia Fire Department\nC Crawford Mechem, MD, MS, FACEP is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine\nMichael E Mullins, MD Assistant Professor, Department of Emergency Medicine, Washington University School of Medicine\nMichael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology and American College of Emergency Physicians\nDisclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None\nJeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut and Connecticut Children's Medical Center\nDisclosure: Merck Salary Employment\nJohn T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals\nJohn T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists\nMary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference\nencoded search term (Hallucinogenic Mushroom Toxicity) and Hallucinogenic Mushroom Toxicity\nAccording to Emergency Physicians\nMore Emergency 'MacGyver' Tips for Physicians\nEscalating Workplace Violence Rocks Hospitals\nAvoiding the 'H Bombs' in Traumatic Brain Injury\nVisits to the Emergency Department Reach New High in CDC Data\nChallenging the One-Hour Sepsis Bundle"