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Amanita Muscaria

Amanita Muscaria

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Amanita Muscaria
Amanita Muscaria

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Published by: Alex on Feb 22, 2014
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Short communication
Fly agaric (
 Amanita muscaria
) poisoning,case report and review
Leszek Satora
, Dorota Pach, Beata Butryn, Piotr Hydzik,Barbara Balicka-S´lusarczyk 
 Department of Clinical Toxicology, Poison Information Center, Collegium Medicum, Jagiellonian University,Os. Złotej Jesieni 1, 31-826 Krako´ w, Poland 
Received 12 November 2004; accepted 10 January 2005Available online 14 April 2005
Gathering and eating mushrooms and other plants containing psychoactive substances has become increasingly popularamong young people experimenting with drugs. Dried fly agaric
 Amanita muscaria
 fruiting bodies were eaten by five youngpersons (18–21 years of age) at a party in order to evoke hallucinations. Visual and auditory hallucinations occurred in four of them, whereas a 18-year-old girl lost consciousness. The following morning, she went to the Clinic of Toxicology. Due to thefact that notall the active substances present inthe flyagaric havebeen identified, and some of them have an effect after a periodof latency, the patient was admitted for several days of observation during which check-up examinations were performed. Afterfour days without any problems, she was discharged. The poisoning regressed with no organ complications. The remainingpersons who had eaten the fly agaric were free from any complaints.
2005 Elsevier Ltd. All rights reserved.
Keywords: Amanita muscaria
; Fly agaric; Mushroom poisoning
1. Introduction
Man has been taking drugs for thousands of years.People have always been interested in substances that havean effect on the mood, perception and the cognition of a newreality. The psychotropic properties of 
 Amanita muscaria
have been known since ancient times. The use of the flyagaric is connected with mysticism. In Poland, there areplants such as
 Datura stramonium
 and hallucinogenicmushrooms that have become an increasingly frequentcause of poisoning, especially in young persons whoexperiment with psychoactive substances. In summer andautumn, mushroom poisoning is a frequent cause of hospitalisation in the Clinic of Toxicology (Satora, 2004).In Poland, the fly agaric cannot be mistaken for any othermushroom.
 A. muscaria
 is commonly found in birch andconiferous tree forests throughout Poland from July toNovember. Its fruiting bodies reach up to 200 mm in height,whereas its caps—even up to 200 mm in diameter. Flyagaric poisoning happens accidentally, especially in chil-dren; however, it is also a cause of deliberate poisoning.Recently, toxicological centres have increasingly dealt withthe practices of getting intoxicated through drinkinginfusions made from those mushrooms or eating the wholefruiting bodies.
2. Case study
Six large fruiting bodies of the fly agaric were gatheredin a city park in Krako´w one morning. The persons whogathered them used a key to mushrooms. Then the caps were
Toxicon 45 (2005) 941–943www.elsevier.com/locate/toxicon0041-0101/$ - see front matter
2005 Elsevier Ltd. All rights reserved.doi:10.1016/j.toxicon.2005.01.005
 Corresponding author. Fax:
48 12 64 68 905.
E-mail address:
 satora@wp.pl (L. Satora).
skinned, shredded and dried in an oven. On the sameevening, the mushrooms were served at a party. They wereeaten with bread and salad by five persons. The participantsdrank a can of beer each. The first clinical manifestationsappeared after about 20 min. Each person (between the agesof 18–21, four males and a female) experienced auditoryand visual hallucinations (heightened colour perception).Disturbing reactions occurred in the 18-year-old girl.Initially, she had severe hallucinations, followed by lossof consciousness. Other partygoers induced her to vomit andmade her drink liquids. Those who had also eaten themushrooms exhibited no symptoms. Due to general debility,tiredness and gastric pain, next day she went to the CasualtyDepartment of the Clinic of Toxicology, Medical College,Krako´w. The patient was weak; palpation revealed tender-ness in the stomach. Bilirubin level was slightly elevated,whereas amino-transferases and prothrombin index werewithin normal limits. No other abnormalities or metabolicdisorders were found in the laboratory investigations of hepatic and renal functions. There was a regular sinusrhythm of 60/min, PQ 113 ms, QT 400 ms in the ECG; thetracing was normal. Urine samples were collected 5 h aftermushroom ingestion, analysis for THC, amphetamine,opiates and amanitin was performed. The results werenegative. Mycological analysis was made and the species of the poisoning-inducing mushroom was determined. Due tothe fact that not all the active substances present in the flyagaric have been identified, and some of them have an effectafter a period of latency, the patient was admitted for aseveral-day observation during which check-up examin-ations were performed. Since the patient complained of gastric tenderness, abdominal ultrasound examination wascarried out. The examination revealed two hyperechoicfoci—steatosis—in the right hepatic lobe. On the followingday, a psychological evaluation was performed. The patientadmitted having experimented with marihuana, hallucino-genic
 mushrooms and drunk beer occasionally. Itwas the first time she had tasted the fly agaric, but its effectmade her refuse to take it any more. The patient wasdiagnosed with puberty-related emotional problems; shewas provided with follow-up psychological care. In thetreatment the patient was administered activated charcoaland nifuroxazide. She received also potassium chloride andfed light diet.
3. Discussion
Despite numerous studies of the substances present inthefly agaric, the correlation between the physicochemicalproperties of the active components and the mode of consumption is still unclear. Ibotenic acid (pantherine,agarine) and muscimol, which are readily soluble in coldwater, are the main active substances contained in the flyagaric. The red skin of the cap and the yellow tissue beneathit contain the highest amounts of these substances. Anothersubstance in the fly agaric is muscazone, which is a lactameisomer of muscimol. The substances have effects on thecentral nervous system (tiredness, confusion), but they actwith a longer latency period. Other substances found in thefly agaric are: choline, acetylcholine, betaine, muscaridine;minor amounts of tropane alkaloids: atropine, hyoscyamine,scopolamine and bufotenine. The possible occurrence in
 A. muscaria
 of amatoxins and phallotoxins—the typicaltoxins of 
 A. phalloides
—is taken into consideration(Michelot and Melendez-Howell, 2003). Ibotenic acid andmuscimol have a structure similar to that of the two mainneurotransmitters of the central nervous system: glutamicacid and GABA. Ibotenic acid and muscimol act likeneurotransmitters involved in the control of neuronalactivity of spinal neurones in the central nervous system(Connor et al., 1991; Michelot and Melendez-Howell,2003). In cats, ibotenic acid is known to act on glutamicacid receptors, whereas muscimol acts on GABA receptors.Ibotenic acid and muscimol cross the blood-brain barrier,most probably by active transport, causing brain disordersby counterfeiting endogenous neurotransmitters (Michelotand Melendez-Howell, 2003). In most cases, one cap is asufficient amount for psychotropic effects (Benjamin, 1992).Clinical manifestations typical of the poisoning with theabove-mentioned
 species are those resemblingalcohol intoxication.
 A. muscaria
 A. panteria
 were usedby witch doctors for inducing hallucinations. In spite of thefact that tropanic alkaloids are not present, the signs andsymptoms of poisoning with the fly agaric are referred to as‘mycoatropinic’ and they resemble those produced by
 Datura stramonium, Atropa belladonna
. They are also referred to as ‘pantherine-muscarine’poisoning syndrome. The first manifestations appear 30 minto 2 h after the mushroom consumption. First, there isdizziness, difficulty in balance and movement coordinationas well as tiredness that sometimes progresses into sleep.Those are followed by psychomotor excitement witheuphoria or depression and anxiety, illusions and visualand auditory hallucinations (Davis and Williams, 1999).The phases of tiredness and excitement may alternateseveral times. There is an increase in body temperature, theskin and mucous membranes are dry, the face is red and thepupils are dilated. Nausea, vomiting and diarrhoea are quitefrequent. In severe poisoning, there is tremor or tonic-clonicseizures with loss of consciousness, followed by a coma. Insuch cases maximum pupillary dilation, loss of corneal,superficial (e.g. abdominal reflex) as well as deep reflexes(e.g. knee reflex) are often observed. In the most severecases, life-threatening respiratory and circulatory disordersmay occur. Sporadically, muscarine-like manifestationsmay appear: sweating and hypersalivation. The duration of clinical manifestations does not usually exceed severalhours. Retrograde amnesia is a frequent result of thepoisoning. The severity of the reaction is proportional to theamount of the mushroom ingested. Tests with rats revealeddecreases in acetylcholine esterase activity, liver glycogen,
 L. Satora et al. / Toxicon 45 (2005) 941–943

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