2.  Amanita phalloides (death cap)  A. verna  A.virosa  Galerina marginata

3.  1-Amatoxins › Α-amanitin › β-amanitin  2-Phallotoxin › Phalloidin

4. Amatoxin: high oral absorb, entrohepatic circulation, renal reabsorption Phallotoxin: very low oral absorption (no oral toxicity) Both : heat stable

5.  Inhibit RNA polymerase ║  Interfere DNA Transcription Protein Synthesis Necrosis

6.  Liver  KIDNEY  PANCREAS  INTESTINE

7.  Bind to actin  Disrupt cell membrane liver  protein synthesis

8.  1-- GI effect (6-24h) › Abdominal pain › nausea › vomiting › Diarrhea › Fever › Hypoglycemia › elecrolyte imbalance

9.  2- Temporary clinical remission (24-72h)  Toxin induce cell injury (misdiagnose)

10.  3--Hepatorenal phase (3-6 days) › Hepatic-renal failure › Pancreatitis › Coagulophaty › Seizure › Coma

11.  Lavage  Charcoal  Diuresis  Electrolyte balance  Vit K  FFP  Glucose

12.  300,000-One million IU/Kg (seizure)  Displace toxin from protein binding renal excretion

13.  140 mg TID  Inhibit toxin uptake by cells  NAC– thioctic acid– hyperbaric(oxygen) regenerate  Hemodialysis- hemopefusion late

14.  Gyromitra esculenta gyromitrin GI methyl formyl hydrazine GI Methyl Hydrazine

15.  Inhibit Pyridoxal Phosphate GABA seizure  liver Nitrosamide Liver Toxicity  Inhibit histaminase His GI effect  Inhibit Dihydrofolate Reductase Anemia  Induce oxidative Stress Hemolysis, Methemoglobinemia

16.  GI: nausea-vomit-abdo pain-diarrhea  CNS: dizziness-headache- seizure -coma  Liver: ALT and AST-coagulopathy- jaundice  Blood: hemolysis-metHb-anemia-  others: hypotension-rhabdomyolysis

17.  metHb > 30% ---- methylene blue + o2 supp  Folinic acid : 5-15 mg/day for 7 day  Pyridoxine: up to 25 mg/kg +diazepam seizure  Vit K – fluid (ringer-lactat) alkaline urine prevent myoglobin deposition

18.  Heat stable  Low oral absorbtion  Clitocybe  Inocybe  No effect on nicotinic receptor  No CNS effect

19.  Cholinergic: › salivation › lacrimation › Diarrhea › Bradycardia › Hypotension › perspiration

20.  Lavage  Charcoal  Ipratropium (inhalation)  Atropine  Glycopyrolate (0.5 to 1 mg ) IV No CNS effect

21. AMANITA MUSCARIA AND AMANITA PANTHERINA

22.  Ibotenic acid NMDA activation excitation  muscimol GABA agonist depression  serotonin, dopamine

23.  Ephoria depression  Agitation somnolence  Amnestic to event during intoxication  GI effect – tremor –ataxia – hallucination-salivation-perspiration- bradycardia  no effect on muscarinic receptors

24.  Charcoal  Quiet, dark room  Diazepam in agitation  No role for atropine  Poison exctract by water (discard water)

25. Psilocybin (heat stable) psilocin

26.  Psilocybe  Gymnopilus  panaeolus

27. Stimulate (5HT 2 A) receptor LSD like effect

28.  Mydriasis  Blurred vision  Hypotension  Tachycardia  Euphoria  Agitation  Hallucination  Hyperthermia  seizure

29.  Charcoal  Quiet and dark room  Diazepam  Antipsychotic worsen hyperthermia Or induce seizure)

30. CHLOROPHYLLUM MOLYBDITES OMPHALOTUS OLEARIUS

31.  Toxin not isolated  Cooking decrease toxicity

32.  Nausea  Vomiting  Abdominal pain  Bloody diarrhea  Bradycardia  Diaphoresis  Chills  dizziness

33. GI effect + muscarinic like effect without salivation and lacrimation

34.  Fluid  Electrolyte  Ondansetron  Charcoal (low effect)

35. CORTINARIUS GENTILIS SPECIO SISSIMUS ORELLANUS AMANITA SMITHIANA

36.  Cortinarius:  Orellanine (heat stable) Disruption of actin and inhibit protein synthesis  Cortinarin A, cortinarin B  A.smithiana :  Aminohexadienoic acid

37.  36h post ingestion! Nausea – vomiting – headache – polydipsia  7-10 day : renal failure (tubulin necrosis) oliguria - anuria

38.  Hemodialysis for a long time is a supportive care ( 50-70 % improve after several weeks)

39.  COPRINUS ATRAMENTARIOUS  COPRINE (HEAT STABLE) AMINOCYCLOPROPANOL

40.  INHIBIT ALDEHYDE DEHYDROGENASE If ethanol ingestion within 48 h after mushroom Flushing-vomiting-tachycardia-arrhythmia

41.  Hemodialysis ethanol acetaldehyde  Fomepizole: inhibit alcohol dehydrogenase

42. RUSSULA SUBNIGRICANS TRICHOLOMA EQUESTER

43.  GI effect + myalgia (myoglobinuria)  Treatment:  Fluid, alkaline urine