Resulting renal failure has been universally responsive to hemodialysis in the case series to date. However, this ingestion has prompted local management recommendations in the Pacific Northwest to include early hemodialysis if historical, clinical, or temporal clues point to Amanita smithiana ingestion.

As previously addressed, positive identification of the mushroom species ingested is rarely possible, and in some instances, any history of ingestion can be difficult to obtain. Syndromic classification, which is an attempt to identify the mushroom species empirically based on the patient’s clinical presentation, is a more clinically oriented approach to mycotoxic presentations. The most recent classification scheme, although complicated, accounts for all current major species ingestions (see table).^7,8

Management

Syndromic classification should be used to identify the possible culprit species of mushroom in any ingestion. From this, many of the specific management details have been addressed in this article. General management of an unknown mushroom ingestion is purposefully conservative, as late effects are often quite serious.

Given the propensity for many mushrooms to affect liver and kidney function, baseline laboratory testing is indicated and can include a complete blood count, metabolic panel, liver function testing, creatine kinase, and urinalysis. Symptomatic control is a mainstay of treatment as well.

In addition, while gastric lavage is controversial in other conditions in emergency medicine, it continues to be recommended in mushroom ingestions as long as it can be completed within 6 hours of ingestion. This will allow specimens to be submitted to mycologic experts for possible identification. Multiple-dose activated charcoal is also recommended, although there is limited evidence of benefit and no randomized trials, given the sporadic nature of toxicologic exposures in general. Disposition recommendations are given for each specific mushroom classification previously addressed.

Summary

While mushroom ingestions are rare and fatalities even more uncommon, poisonings are increasing globally. Syndromic classification should be the initial aim of evaluation, and specific management then can be tailored to the most likely mushroom species.