Presenting Symptoms or Laboratory Abnormality / Associated Features / Mushroom
Class/Toxin / Species / Treatmenta
Hallucinations / Mydriasis, tachycardia, coma, seizures
Mild hallucinations, coma, myoclonus, seizures / Psilocin
Ibotenic acid/muscimol / Psilocybe and Concocybe sp.
Amanita muscaria, pantheria, gemmata / Benzodiazepines
Low-stimulus environment
Benzodiazepines
Low-stimulus environment
Cholinergic signs / “DUMBELS”c / Muscarine / Clitocybe and Inocybe sp., Omphalotus olearius / Atropine for pulmonary symptoms
Disulfiram reaction / N/V/D, flushing, ↑HR assoc. with ethanol use / Coprine / Coprinus sp. / Antihistamines
Renal failure / Delayed GI symptoms / Orellanineb / Cortinarius sp. / Supportive/ hemodialysis
Early GI symptoms / Allenic norleucineb / Amanita smithiana / Supportive/ hemodialysis
Rhabdomyolysis / Myalgias, fatigue / Unknown myotoxinb / Tricholoma equestre / Maintenance of urine output, ± urinary alkalinization
Early gastrointestinal symptoms (2–3 h) / N/V/D / GI irritants / Chlorophyllum sp., many others / Supportive care only
Antiemetics
Delayed gastrointestinal symptoms (>6 h) / Delayed hepatotoxicity / α-amanitinb / A. phalloides, virosa, Lepiota sp. / Multi-dose activated charcoal
Penicillin
N-acetylcysteine
Silibinin?
Consider transplant
Delayed nephrotoxicity / Orellanineb / Cortinarius / Supportive/ hemodialysis
N/V/D, CNS, Hepatic / Gyromitrinb
(monomethyl hydrazine) / Gyromitra sp. / Pyridoxine
aIn addition to supportive care including intravenous fluids and antiemetics, and decontamination if appropriate
b Mushrooms that lead to potentially lethal poisoning
cDUMBELS, (diarrhea, urination, miosis, bradycardia, bronchorrhea, bronchospasm, emesis, lacrimation)
Plant Name* Toxin/ toxic Effect Treatment/ Antidote
*Plants are organized by general
mechanism of toxicity
Oleander (Nerium and Thevetia spp.) Cardiac Glycoside (Digoxin-like) Digibind, atropine
Foxglove, Lilly of the valley
Squills (Urginea spp.)
Poison hemlock (Conium maculatum) Coniine/ Nicotinic effects: Supportive
N/V, Sympathomimetic, Fasciculations, Sz
Water hemlock (Cicuta maculate) Cicutoxin/ Cholinergic signs, Supportive, ± Atropine
Intractable seizures BENZO’s!!
Jimsonweed (Datura stramonium) Antimuscarinic (anticholinergic) alkaloids Benzo’s, Physostigmine
Belladonna (Atropa belladonna) (e.g. atropine, scopolamine, hyoscyamine)
True Mandrake (Mandragora officinarium)
Monkshood (Aconitum napelius) Aconitine/ Na Ch opener Atropine/ Pacing
-Ventricular dysrhythmias ± Amiodarone
-Paresthesias/ paralysis/ seizures
Apricot seed kernels Cyanogenic glycosides Hydroxocobalamin (Cyanokit)
Other prunus genus: (amygdalin)à cyanide
(plum, pear, cherry, almond, peach)
Castor beans (Ricinus communis) Ricin à Interrupts protein synthesis Supportive
Rosary pea (Abrus precatorius) Abrin à Interrupts protein synthesis
Autumn crocus (Colchicum autumnale) Colchicine à inhibits mitosis à MODS Supportive, ± cGSF
May apple (Podophyllum peltatum) Podophyllin à inhibits mitosis à MODS
Yew (Taxus spp.) Taxanes/ Na Ch blockade Supportive, Atropine
-Bradycardia, wide complex dysrhythmias ? NaHCO
Ackee fruit (Blighia sapida) Hypoglycin A à Jamaican vomiting sickness Supportive, Benzo’s
N/V, Seizures, Profound hypoglycemia Glucose, ± L-carnitine