Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Emergency Medicine, Atlanta VA Healthcare System, Atlanta, GA.
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
Wilderness Environ Med. 2022 Dec;33(4):412-416. doi: 10.1016/j.wem.2022.06.002. Epub 2022 Oct 6.
Ingestion of Amanita muscaria mushrooms results in transient central nervous system excitation and depression mediated by its components, ibotenic acid and muscimol. The mushroom is distributed worldwide and ingestions occur with some frequency. Although these ingestions have traditionally been considered benign, serious complications can occur. We present 2 cases of serious toxicity, including a fatality. The first case was a 44-y-old man who presented to the emergency department (ED) after cardiopulmonary arrest approximately 10 h after ingesting 4 to 5 dried A muscaria mushroom caps, which he used for their mind-altering effects. Despite successful resuscitation, he remained unresponsive and hypotensive and died 9 days later. The second case was a 75-y-old man who presented to the ED after accidentally consuming one large A muscaria mushroom cap he foraged in Eastern Turkey. The patient initially presented to the ED with hallucinations followed by lethargy, and he was intubated for airway protection. The patient's condition gradually improved, and he made a full recovery. A muscaria ingestion should not be considered benign as serious outcomes do occur. An understanding of how the main neuroactive chemicals, ibotenic acid and muscimol, affect the brain can help anticipate outcomes. Several high-risk features that portend a more serious course are identified.
食用鹅膏蕈类会导致其中的成分——鹅膏蕈氨酸和 muscimol——引起短暂的中枢神经系统兴奋和抑制。这种蘑菇分布于世界各地，人们会时不时误食。尽管这些误食通常被认为是良性的，但也可能会出现严重的并发症。我们报告了两例严重毒性反应的病例，其中一例死亡。第一例是一名 44 岁男性，在摄入 4 到 5 个干燥的鹅膏蕈蕈帽后约 10 小时出现心肺骤停，被送往急诊室（ED）。尽管成功复苏，但他仍处于昏迷和低血压状态，并于 9 天后死亡。第二例是一名 75 岁男性，在误食了他在土耳其东部采集的一个大型鹅膏蕈蕈帽后被送往 ED。患者最初出现幻觉，随后出现昏睡，并因气道保护而插管。患者的病情逐渐好转，完全康复。食用鹅膏蕈类不应被视为良性，因为确实会出现严重后果。了解主要神经活性化学物质——鹅膏蕈氨酸和 muscimol——如何影响大脑可以帮助预测结果。确定了几个预示更严重病程的高风险特征。
