Inocybe
Background
Inocybe geophylla
- Genus of potentially poisonous mushroom
- Many species contain muscarine, a toxin that causes cholinergic symptoms
- Rare species contain the hallucinogenic psilocybin
Clinical Features
- Symptoms usually start within 0.5-2hrs and resolve within 12hrs[1]
- Muscarine
- SLUDGE(M) syndrome (hyperperistalsis)
- Salivation, Lacrimation, Urination, Diarrhea, GI pain, Emesis, Miosis
- Bradycardia
- Miosis
- Bronchorrhea / Bronchospasm
- Sweating
- Vasodilation
- SLUDGE(M) syndrome (hyperperistalsis)
- Psilocybin
- Sensory/psychiatric
- Euphoria, visual hallucinations, synesthesia
- Lethargy, depression, anxiety, agitation
- Confusion, disorientation
- Sympathetic effects
- Mydriasis
- Tachycardia, hypertension
- Sensory/psychiatric
Differential Diagnosis
Mushroom toxicity by Type
| Mushroom | Toxin | Pathologic Effect |
| Amanita | Amatoxin | Hepatotoxicity |
| Coprine | Disulfiram-like | |
| Crotinarius | Orellanine | Delayed renal failure |
| Gyromitra | Gyromitrin | Seizures |
| Ibotenic Acid | Anticholinergic | |
| Muscarine | Cholinergic | |
| Orellanin | Nephrotoxicity | |
| Psilocybin | Hallucinations |
SLUDGE Syndrome
- Carbamate toxicity
- Mushroom toxicity, especially:
- Organophosphate toxicity
- Nerve agent
- Sarin
- VX
- Novichok agent
- Nicotine toxicity (look alike)
- Acetylcholinesterase inhibitor overdose (e.g in myasthenia gravis or post anesthesia reversal)
Evaluation
- Clinical diagnosis
- Evaluate for alternative etiology of symptoms
Management
- Atropine PRN for muscarinic symptoms
- Supportive care, benzos for unpleasant psilocybin symptoms
Disposition
See Also
External Links
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