Cases Of Mushroom Poisoning Research Articles

Poisoning Case of Chlorophyllum cf. molybdites in Indonesia

Wild edible mushrooms are one the germplasms which consumed by some people in Indonesia. However, due to the similar morpholgical appearance from one mushroom to another, cases of wild mushroom poisoning might be occurred as the result of the misidentification at foraging time. One of the common poisonous mushrooms which easily found around residence area is Chlorophyllum molybdites. To date, there is no database of mushroom poisoning cases in Indonesia. The aims of this research was to provide the information regarding C. molybdites poisoning cases in Indonesia. This is a literature-based quantitative research. During the last 10 years, it is suspected that there have been 4 cases of Chlorophyllum cf. molybdites poisoning in Indonesia with a total of 34 victims and none has died. This mushroom is known to contain toxic compounds, namely polymeric protein. The main constraint related to determining the taxonomic identity of poisonous mushroom, is the lack of information and documentation of samples that cause poisoning in Indonesia. This research explained how to recognize the character of C. molybdites, information on its distribution, and its toxicity aspects. With the complete information as a medium for disseminating mycology knowledge, it is hoped that cases of wild mushroom poisoning can be prevented in the future in Indonesia.

From activated charcoal to selective plasma exchange: A retrospective analysis of mushroom poisoning cases treated in the intensive care unit

Introduction: This study aims to evaluate presenting symptoms, clinical and laboratory findings, and treatment modalities of adult patients presenting with mushroom poisoning treated in the intensive care unit (ICU) with special consideration of extracorporeal liver support systems.
 Materials and methods: Records of patients with mushroom poisoning treated in the ICU between January 2007 and December 2014 were analyzed retrospectively.
 Results: Sixteen adult patients were treated in the ICU for mushroom poisoning during the designated study period. Presentation to the hospital was most common during October of each year. Average time from ingestion of mushrooms to first symptoms was 17.81 hours, and to ICU admission was 2.38 days. The most common symptoms were nausea, vomiting and diarrhea. The most common laboratory finding was elevation of liver transaminases. In cases with elevated liver transaminases, penicillin G, silibinin and N-acetyl cysteine were used. Extracorporeal support systems were used in 9 cases. Two cases underwent emergency liver transplantation.
 Conclusion: Liver transplantation is the most definitive and effective treatment in indicated cases of mushroom poisoning. Extracorporeal support systems should be considered in the early period both as a treatmet modality on their own or to save time until the definitive treatment is possible. The question of which extracorporeal detoxification technique to use is difficult to answer and controlled clinical trials which compare their efficacy are needed.

Forensic differentiation of amanita mushrooms using atr-ftir spectroscopy coupled with chemometrics

In mushroom poisoning cases, genus Amanita is responsible for majority of fatalities. Most of such cases are due to the accidental consumption of inedible mushrooms, but there is a high probability of their use forhomicidal purposes. Mushroom species can be identified based on the morphological features, however, in the field of forensic science,available exhibits are recovered in trace amounts, which pose a serious challenge before the forensic experts to analyse the samples in a non-destructive manner. In current work, ATR FT-IR spectroscopy has been used for the non-destructive identification and differentiation of six species of genus Amanita. To distinguish the selected mushroom species, chemometric tools like PCA and PLS-DA were applied. All samples were not successfully classified using the PCA model, therefore the PLS-DA model was applied to enhance the classification rate. PLS-DA model yielded a significant classification rate for the differentiation among the samples of different wild mushroom species. Furthermore, blind validation test was conducted and all unknown samples were classified accurately to their respective class. The obtained R-square value for PLS-DA model was 0.99 which is highly significant for the prediction accuracy.

A Report on Mushrooms Poisonings in 2018 at the Apulian Regional Poison Center

BACKGROUND: The “Ospedali Riuniti’s Poison Center” (Foggia, Italy) provides a 24 h telephone consultation in clinical toxicology to the general public and health-care professionals, including drug information and assessment of the effects of commercial and industrial chemical substances, toxins but also plants and mushrooms. It participates in diagnosis and treatment of the exposure to toxins and toxicants, also throughout its ambulatory activity.
 METHODS: To report data on the epidemiology of mushroom poisoning in people contacting our Poison Center we made computerized queries and descriptive analyses of the medical records database of the mushroom poisoning in the poison center of Foggia from January 2018 to December 2018.
 RESULTS: A total of 69 mushroom poisonings cases were recorded in our poison center the period from January 2018 to December 2018. Our poison center serves all the Italian territory but most of the calls about mushrooms poisonings, in 2018, came from Apulia, Campania, and Basilicata, which are bordering regions of Italy. About 80.2 % of calls were made by the physicians (particularly, 73.9% by emergency room, 18.8% and 4.3% by hospital ward, and 1.4% both by a general practitioner and by the American Sign Language [“ASL”]) and 18.8% by the public. Cooked mushrooms were involved in all the cases (single and multiple species). The most frequent calls were made in the period between September 2018 and December 2018; in the other months, there were only sporadic cases. All were intentional exposures in adults (>18 years).
 CONCLUSIONS: Mushroom exposures and poisonings are an important problem in those regions of Italy where many people adventuring in mushroom’s research without any license. This fact has contributed substantially to morbidity due to mushroom poisoning. Our database is a valuable national resource for the collection and monitoring of Italian mushroom poisoning cases in 2018 but limited to the people who called our poison center, which is one of the nine poisons centers in Italy. And since in most cases, the mushroom’s species remains unknown, it is important to quickly recognize symptoms and most frequent species involved on the Italian territory, in particular in South Italy.

Demographic and epidemiologic evaluation of mushroompoisoning: a retrospective study in 4-year admissions of Razi Hospital (Qaemshahr, Mazandaran, Iran).

Aim Wild mushroom intoxication is a public health problem, which causes a wide range of symptoms: from mild gastrointestinal symptoms to multiple organ failure and death. The present study aims to evaluate the epidemiology of mushroom intoxication in 4-year admissions of Razi Hospital, Qaemshahr, Mazandaran, Iran. Methods Medical records of all identified cases of mushroom poisoning admitted during the period between 2015 and 2018 were extracted and patients' demographic data including age, sex, latency period, season of poisoning, clinical presentations, laboratory findings, prognosis, duration of hospitalization and therapeutic interventions were recorded. Results A total of 65 mushroom poisoning cases were identified (mean age of 35.68 years), of which 32 (49.2%) were females. Latency of ≤ 6 hours was seen in 63 (96.4%) cases. The most prevalent season of intoxication was spring (60.7%). The most frequent symptoms were nausea and vomiting (86.5%) and abdominal pain (51.2%). No case required intensive care unit (ICU) care or mechanical ventilation. Mean hospital stay was 1.89 days without any mortality. Mean aspartate aminotransferase (AST) level was 21.89 (±9.55), but the disturbance of liver function tests (LFTs), coagulopathy, elevated level of bilirubin and/or platelet was not noted. In 93% of patients ranitidine, in 7% Penicillin G, and in 3.6% cefaclor and ceftriaxone was administrated. Conclusion People and health care providers must be educated about mushroom poisoning. Prompt transfer of suspicious cases with history of wild mushroom ingestion to the emergency department is crucial since patients showing toxicity symptoms after 6 hours might have worse and mortal prognosis despite treatment.

Mushroom Poisoning of 1151 People in Iran; the Lessons Learnt: A Brief Report of Cases and the Literature Review

Background: In Spring 2018, due to intense rainfalls in Iran, plenty of mushrooms had grown, some of which were poisonous and their consumption had induced poisoning in people of different provinces; 1151 mushroom poisoning cases were reported within 25 days from 12 May to 9 July 2018. Objectives: This study aimed to address this issue from the public health perspective. The study further aimed at reporting the mortality and morbidity associated with mushroom poisoning and ascertaining the reasons behind the increase in the numbers of the affected persons. Methods: This report was based on the review of official reports and a field assessment in the areas affected by mushroom poisoning in the western part of Iran. Results: There were 1151 mushroom poisoning cases, out of which 1133 (98.4%) were hospitalized, and unfortunately, 18 (1.56%) died. Kermanshah province had the highest rate of mushroom poisoning casualties, out which seven people died. A total of 12 provinces were affected. Conclusions: Lack of knowledge of local people about the types of mushroom and their inability to differentiate between the toxic and non-toxic mushrooms, as well as lack of a swift and convenient immediate warning system has caused this incident of massive mushroom poisoning. However, planning and proper management can help to resolve these problems.

Гігієнічні та токсикологічні аспекти отруєнь дикорослими грибами (огляд даних літератури та результати власних досліджень)

ABSTRACT. Unsettling statistics of poisoning resulting from the use of wild-growing mushrooms necessitates a more detailed study of the life-threatening causes in human and determination of preventive measures. Objective. Analysis of the structure, changes over time and causes of poisoning by wild-growing mushrooms among the population of Kyiv and the Region of Kyiv in recent years. Materials and Methods. Cases of mushroom poisoning (ICD–T62.0) among the adult population of Kyiv; statistic data from the Ministry of Health of Ukraine, the State Emergency Service of Ukraine and the toxicological centre of the Kyiv City Clinical Emergency Hospital. Study methods used: analytical, systemic and comparative analysis. Results and Discussion. In the general structure of acute poisoning, cases of mushroom poisoning account for 3%. The average hospital mortality rate is 9.3%. Among the aetiological factors, poison amanita prevails, conditionally edible mushrooms are in the second place, and edible mushrooms, which acquired toxic properties due to anthropogenic pollution of the environment are in the third place. The following abnormal conditions were found in poisoned persons: toxic gastroenterocolitis (81.4%), toxic neuropathy (2.1%), toxic hepatonephropathy (16.2%). It was established that the risk groups for poisoning associated with mushrooms are the population with a lack of understanding of the possible danger of eating mushrooms: unskilled workers, unemployed, school and preschool children and inhabitants of large cities who have no stranger in picking mushrooms (mainly men). In general, poisoned persons showed a low level of awareness of the danger and lack of knowledge about the means of preventing poisoning at the stages of picking, sorting and preparation of mushrooms and the rules of primary health care. Low efficacy of prevention against seasonal mushroom poisoning remains one of the factors of high morbidity and mortality. Conclusion. The study revealed that seasonal poisoning with wild-growing mushrooms remains an important medical and social problem in most regions of Ukraine. In recent years, measures of sanitary supervision and control in the field of prevention of seasonal mushroom poisoning have been significantly worsened. The situation requires the restoration of an integrated approach to preventive actions to prevent harm to life and health when eating wild-growing mushrooms. Key Words: sanitary and hygienic monitoring, mushroom poisoning.

An effective antidotal combination of polymyxin B and methylprednisolone for α-amanitin intoxication.

Amanita phalloides is one of the most toxic mushrooms worldwide, and it is involved in the majority of human fatal cases of mushroom poisoning. α-Amanitin, the most deleterious toxin of A. phalloides to humans, inhibits RNA polymerase II (RNAPII), causing hepatic and renal failure. Previously, we have shown that polymyxin B (polB) reverts α-amanitin inhibition of RNAPII, although it was not able to guarantee the full survival of α-amanitin-intoxicated mice or prevent α-amanitin pro-inflammatory effects. α-Amanitin is also a substrate of the organic-anion-transporting polypeptide 1B3 (OATP1B3) and Na(+)-taurocholate cotransporter polypeptide (NTCP) transporters. Therefore, in the present work, we used a combination of polB [(2.5mg/kg intraperitoneal (i.p.)] with the anti-inflammatory and NTCP inhibitor drug, methylprednisolone (MP) (10mg/kg i.p.), as an attempt to fully revert α-amanitin-induced toxicity (0.33mg/kg i.p.) in CD-1 mice. Results showed that the administration of the polB + MP combination, 4h after α-amanitin, led to the full survival of the intoxicated animals, with a significant attenuation of α-amanitin-induced renal and hepatic necrosis. Also, the combination polB + MP led to a decrease of aminotransferase plasma levels, of the renal myeloperoxidase activity and of renal inflammatory cell infiltrate promoted by α-amanitin, although not preventing any of the hepatic pro-inflammatory effect of the toxin. The obtained results indicate that this combination may represent an important and valuable therapeutic approach to be used against α-amanitin intoxication.

Mushroom Poisoning Cases from an Emergency Department in Central Anatolia: Comparison and Evaluation of Wild and Cultivated Mushroom Poisoning

Mushroom Poisoning Cases from an Emergency Department in Central Anatolia: Comparison and Evaluation of Wild and Cultivated Mushroom Poisoning

Mushroom Poisoning Cases From an Emergency Department in Central Anatolia: Comparison and Evaluation of Wild and Cultivated Mushroom Poisoning

Mushroom Poisoning Cases From an Emergency Department in Central Anatolia: Comparison and Evaluation of Wild and Cultivated Mushroom Poisoning

A case of nursing care of special severe sulfuric acid burn combined with hepatolenticular degeneration

Objective: To investigate a poisonous mushroom poisoning incident and analyze its clinical data. Methods: Investigate a poisonous mushroom poisoning incident in a place in Shandong in July 2018, at the same time, the clinical data of 2 cases of mushroom poisoning were analyzed and summarized. Results: The incident was caused by a poisoning incident caused by residents eating poisonous mushrooms. The poisonous mushroom in this incident was identified as a scaled white goose cream. Two patients with poisoning developed gastrointestinal symptoms such as nausea and vomiting, abdominal pain and diarrhea, and liver damage occurred later. After active rescue and treatment, one patient was discharged from hospital, and the other patient developed acute pulmonary embolism during the treatment. He was discharged after interventional thrombolysis and follow-up treatment. Conclusion: After investigation, the incident was caused by the ingestion of poisonous mushrooms mainly based on the scalloped white goose cream. After active treatment, they were cured and discharged.

Simultaneous identification and characterization of amanita toxins using liquid chromatography-photodiode array detection-ion trap and time-of-flight mass spectrometry and its applications

Rapid and accurate identification of multiple toxins for clinical diagnosis and treatment of mushroom poisoning cases is still a challenge, especially with the lack of authentic references. In this study, we developed an effective method for simultaneous identification of amanita peptide toxins by liquid chromatography coupled with photodiode array detection and ion trap time-of-flight mass spectrometry. The accuracy and selectivity of the methodology were validated through similar multiple fragmentation patterns and characteristic ions of standard α- and β-amanitin. The developed method could successfully separate and identify major toxic constituents in Amanita mushrooms. Two amatoxins and three phallotoxins were confirmed in a single run through their fragmentation patterns and characteristic ions, which can be used as diagnostic fragment ions to identify mushroom toxins in complex samples. Furthermore, the performance of the developed method was verified by using real biological samples, including plasma and urine samples collected from rats after intraperitoneal administration of toxins. Thus, the development methodology could be crucial for the accurate detection of mushroom toxins without standard references.

A 3-Year Survey of Mushroom-Poisoned Patients: Clinical Features, Management and Outcomes

Background:Besides their nutritional value, mushrooms have shown beneficial effects on human body organs; thus, people are interested in consumption of mushrooms regardless of their safety. In this report, we present patients with suspected mushroom poisoning, who were admitted to the Medical Toxicology Department of Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Method:Seventeen mushroom-poisoned patients were admitted to our department from April 2012 to May 2015. Following the evaluation of the vital signs, biochemical analysis was done and in parallel, treatment was initiated based on the laboratory tests results and clinical manifestations. Results:In this period, 17 mushroom-poisoned individuals (11 males (64.7%) and 6 females (35.3%) with mean age of 28.26±18.05 years old) were referred to our department. Subjects presenting the signs of intoxication within 6 hours post-ingestion comprised 58.8% of our patients. The rate of mortality was zero but 3 patients presented with some levels of unconsciousness. Only one patient had augmented levels of AST with no evidence of hepatic failure. Coagulopathy as reflected by increased INR was observed in 2 patients. Regarding the season in which the poisoning occurred, the majority of cases happened in spring and autumn. Conclusion:Similar to other reports on mushroom-poisoned patients, we observed gastrointestinal disturbances as the major symptom. Since the majority of mushroom poisoning cases occur following the ingestion of accidentally picked mushrooms, risk communication practices should be improved to increase the public awareness of mushrooms toxic effects.

Analysis of spatiotemporal patterns and influential factors for mushroom poisoning in Hunan Province in 2015

To understand the spatial distribution of mushroom poisoning in Hunan Province and its influential factors, and to provide the evidence for control of the mushroom poisoning. Methods: The surveillance data for mushroom poisoning cases from 122 counties in Hunan Province in 2015 were collected. Based on geographical information system database, spatial autocorrelation analysis and spatial regression analysis (via OpenGeoDa) was conducted. Results: The incidence of mushroom poisoning in Hunan Province in 2015 was 2.94/100 000. Global Moran's I values was 0.315 (P<0.05). Local spatial autocorrelation analysis indicated that Ningxiang, Xiangtan, Shaoyang, Lingling, Jiahe, and Linwu districts et al were "positive hotspot" regions. Guzhang, Hecheng, Dingcheng, Yueyang districts et al were "negative hotspot" regions. Spatial regression analysis revealed that the reported incidence of mushroom poisoning was positively correlated with the annual average temperate (Z=2.145, P=0.032), the number of health care institutions per capita (Z=2.352, P=0.019), and the number of students enrollment in secondary schools (Z=4.309, P<0.001). It was negatively associated with the number of school staff and workers of secondary schools (Z=-2.626, P=0.009). Conclusion: The spatial distribution of mushroom poisoning cases in Hunan Province in 2015 is highly clustered. Mushroom poisoning cases are more prevalent in the middle and southern regions and less prevalent in the northern areas of the province. The annual average temperate and the number of students enrollment in secondary schools demonstrate a certain positive influence on the distribution of mushroom poisoning in Hunan.

Mushroom Poisoning in the Northeast of Iran; a Retrospective 6-Year Epidemiologic Study.

Toxic mushrooms are distributed across the globe with over 5000 species. Among them, 100 species are responsible for most of the cases of mushroom poisoning. This study aimed to evaluate the epidemiologic pattern of mushroom poisoning among patients referred to the main toxicology center of Mashhad province located in North-east of Iran. This cross-sectional study was conducted on patients with final diagnosis of mushroom poisoning referred to the toxicology center of Mashhad, Iran, from February 2005 to 2011. Patients' demographic characteristics, clinical presentations, laboratory findings, outcomes, and therapeutic measures were collected using a predesigned checklist and searching patient's profile. 32 cases with the mean age of 24.6 ± 16.7 years were presented to the toxicology center following mushroom poisoning (59% female). Mushroom poisoning accounted for 0.1% of all admitted cases. The mean time elapsed from consumption to referral to poisoning department was 61.9 ± 49.4 hours. 19 (59%) cases were discharged with complete recovery, 7 (22%) expired, and 6 (19%) cases left hospital against medical advice. Mushroom poisoning mortality accounted for 1.5% of deceased cases in the studied center. There was significant relationship between mortality rate and higher values of INR (p = 0.035), PT (p = 0.011) and PTT (p = 0.003). Likewise, there was significant relationship between the need for mechanical ventilation and higher values of INR (p = 0.035), PT (p = 0.006) and PTT (p = 0.014). The relationships between the need for ICU admission, mechanical ventilation, and mortality rate with the rise of hepatic transaminases and serum bilirubin were not significant. Based on the findings, the prevalence of mushroom poisoning among patients referred to Mashhad toxicology center was very low (0.1%), but with a high mortality rate of 22%. Nausea and vomiting were the most common early symptoms of intoxication and higher values of coagulation profile were correlated with poor outcome.

Mushroom poisoning: a retrospective study concerning 11-years of admissions in a Swiss Emergency Department.

Wild mushroom intoxication is an unusual cause of toxic ingestion in Europe. A great diversity of clinical symptoms may arise depending on the variety of wild mushrooms ingested. These initial symptoms are often non-specific, with frequent gastrointestinal symptoms, and have no direct correlation with the outcome. Therefore, management of mushroom poisoning and risk evaluation are a challenge for emergency clinicians. We retrospectively reviewed all cases of mushroom poisoning identified in the ED database spanning 11years. Demographic and clinical data, time from consumption to symptoms, type of mushrooms, the number of patients presenting at the same time, treatment(s) provided, length of stay, discharge diagnosis, in-hospital mortality, and serious complications were evaluated. We identify 87 cases of mushroom poisoning. The most common symptoms are nausea and vomiting (71 cases, 82%), followed by diarrhea (68%), syncope (10%), abdominal pain (8%), and hallucinations (7%). Sixty-four patients (74%) exhibited early symptoms (appearance <6h after ingestion) and 23 (26%) late symptoms (appearance >6h after ingestion). Eleven patients (13%) required hospitalization over 24h. Patients with late symptoms tended to have longer in-hospital lengths of stay. Only one patient had Amanita phalloides intoxication, with a favorable outcome. Thirty-eight patients (44%) were involved in cluster presentations. Mushroom poisoning is an unusual but potentially severe form of intoxication. Patients presenting with late-appearing symptoms (>6h) are associated with a higher risk of A. phalloides intoxication, and therefore require specific investigation and management.

Mushroom poisoning in Hong Kong: a ten-year review.

Mushroom poisoning is a cause of major mortality and morbidity all over the world. Although Hong Kong people consume a lot of mushrooms, there are only a few clinical studies and reviews of local mushroom poisoning. This study aimed to review the clinical characteristics, source, and outcome of mushroom poisoning incidences in Hong Kong. This descriptive case series review was conducted by the Hong Kong Poison Information Centre and involved all cases of mushroom poisoning reported to the Centre from 1 July 2005 to 30 June 2015. Overall, 67 cases of mushroom poisoning were reported. Of these, 60 (90%) cases presented with gastrointestinal symptoms of vomiting, diarrhoea, and abdominal pain. Gastrointestinal symptoms were early onset (<6 hours post-ingestion) and not severe in 53 patients and all recovered after symptomatic treatment and a short duration of hospital care. Gastrointestinal symptoms, however, were of late onset (≥6 hours post-ingestion) in seven patients; these were life-threatening cases of amatoxin poisoning. In all cases, the poisonous mushroom had been picked from the wild. Three cases were imported from other countries, and four collected and consumed the amatoxin-containing mushrooms in Hong Kong. Of the seven cases of amatoxin poisoning, six were critically ill, of whom one died and two required liver transplantation. There was one confirmed case of hallucinogenic mushroom poisoning caused by Tylopilus nigerrimus after consumption of a commercial mushroom product. A number of poisoning incidences involved the consumption of wild-harvested dried porcini purchased in the market. Most cases of mushroom poisoning in Hong Kong presented with gastrointestinal symptoms and followed a benign course. Life-threatening cases of amatoxin poisoning are occasionally seen. Doctors should consider this diagnosis in patients who present with gastrointestinal symptoms that begin 6 hours or more after mushroom consumption.

Molecular identification of poisonous mushrooms using nuclear ITS region and peptide toxins: a retrospective study on fatal cases in Thailand.

Cases of mushroom poisoning in Thailand have increased annually. During 2008 to 2014, the cases reported to the National Institute of Health included 57 deaths; at least 15 died after ingestion of amanitas, the most common lethal wild mushrooms inhabited. Hence, the aims of this study were to identify mushroom samples from nine clinically reported cases during the 7-year study period based on nuclear ITS sequence data and diagnose lethal peptide toxins using a reversed phase LC-MS method. Nucleotide similarity was identified using BLAST search of the NCBI database and the Barcode of Life Database (BOLD). Clade characterization was performed by maximum likelihood and Bayesian phylogenetic approaches. Based on BLAST and BOLD reference databases our results yielded high nucleotide similarities of poisonous mushroom samples to A. exitialis and A. fuliginea. Detailed phylogenetic analyses showed that all mushroom samples fall into their current classification. Detection of the peptide toxins revealed the presence of amatoxins and phallotoxins in A. exitialis and A. fuliginea. In addition, toxic α-amanitin was identified in a new provisional species, Amanita sp.1, with the highest toxin quantity. Molecular identification confirmed that the mushrooms ingested by the patients were members of the lethal amanitas in the sections Amanita and Phalloideae. In Thailand, the presence of A. exitialis was reported here for the first time and all three poisonous mushroom species provided new and informative data for clinical studies.

Mushroom Poisoning in a Metropolitan Hospital

Objective: We aimed to investigate suspected cases of mushroom poisoning that were admitted to the emergency department of a metropolitan education and research hospital. Material and Methods: Suspicious cases of mushroom poisoning and determined mushroom poisoning patients were investigated in the medical records of patients who were older than 18 years old in 1 year. We examined patient’s demographic information, admission date, complaints, time of complaint starting, and clinical and laboratory findings. Treatments and results were evaluated. Results: We analyzed 74 patients who were diagnosed with mushroom poisoning. The most common complaints of the patients were nausea and vomiting. Increases in the number of admission were observed in November and December. A total of 25 patients were externed from emergency medicine, and 39 patients were hospitalized. 5 patients treatment with hemodialysis and both of them died. Conclusion: Mushroom poisoning is known to vary according to seasonal distribution, type of mushroom, geographic shape, and climate of the region. Therefore, emergency physicians should investigate the characteristics and ecology of the region and the geographic shape, so that provision services can facility the emergency departments principles working and organizated. The importance of regional characteristics is lost in a metropolitan hospital. (JAEM 2014; 13: 162-5)

Assessment of patients who presented to the emergency department with mushroom poisoning

This study aimed to assess the demographic characteristics, emergency department (ED) complaints, laboratory findings, and latent phase periods of patients who presented to the ED due to mushroom poisoning (MP) as well as the efficacy of conventional and hemofiltration therapies. The study was conducted on patients who presented to the ED with MP between 2010 and 2012. The patient's demographic characteristics, complaints at the ED, latent phases, laboratory findings, and treatments of MP cases were evaluated. The mean age of patients was 38.03 ± 15.96, where 63.8% of them were female and 36.2% were male. Visits occurred most frequently in the autumn (32.6%). When presenting to the ED, the most frequent complaint was nausea-vomiting. The aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalised ratio (INR), and blood urea nitrogen values of patients with a latent phase between 0 h and 5 h were significantly lower than the values of patients with a latent phase between 6 h and 24 h. In this study, 62% of the patients (n = 36) had stomach lavage and received activated charcoal. Altogether, 55.2% of the patients had received conventional therapy, 37.9% of them received hemofiltration, and all of them received supportive treatment. The AST, ALT, and INR values of those who had received hemofiltration and conventional therapies were significantly higher than of those who received only supportive treatment (p < 0.01). Hemofiltration, in combination with conventional therapy, seems to be an effective treatment for reducing mortality in suspected MP cases involving late acting toxins.