Cholinergic Mushroom Poisoning With a Detection of Muscarine Toxin in Urine.
Tina Yee Ching ChanSau Wah NgChi Keung ChanHencher Han Chih LeeTony Wing Lai MakPublished in: Journal of medical cases (2023)
We report an uncommon case of cholinergic poisoning following an ingestion of wild mushrooms. Two middle-aged patients presented to the emergency unit with acute gastrointestinal symptoms including epigastric pain, vomiting and diarrhea, followed by miosis, palpitations and diaphoresis which were compatible with a cholinergic toxidrome. The patients volunteered a history of taking two tablespoons of cooked wild mushrooms collected in a country park. Mildly elevated liver transaminase was noted in one female patient. Mushroom specimens were sent to a mycologist for identification using morphological analysis. Muscarine, a cholinergic toxin found in mushrooms such as Inocybe and Clitocybe species, was subsequently extracted from and identified in the urine specimens of both patients, using a liquid-chromatography tandem mass spectrometry method. In this report, the variable clinical presentation of cholinergic mushroom poisoning is discussed. Key issues in the management of these cases were presented. In addition to conventional mushroom identification methods, this report also highlights the use of toxicology tests on different biological and non-biological specimens for diagnosis, prognosis and surveillance purposes.
Keyphrases
- end stage renal disease
- liquid chromatography tandem mass spectrometry
- ejection fraction
- newly diagnosed
- chronic kidney disease
- escherichia coli
- public health
- emergency department
- middle aged
- chronic pain
- patient reported outcomes
- depressive symptoms
- simultaneous determination
- case report
- neuropathic pain
- spinal cord injury
- sleep quality
- high resolution
- liver failure
- liquid chromatography
- extracorporeal membrane oxygenation
- aortic dissection
- real time pcr