13. Mushrooms and Big Naturals

syndrome

First principle of mushrooms: identify the __________, not just the mushroom

there is not

Is there a simple test to give you a reasonable way to separate 'poisonous' from 'safe' mushrooms?

If so, what is it?

paper

When you collect intact mushroom specimens from the exposure area, use _________ to contain it and record the environment (substrate, moisture, nearby trees, location)

GI, minutes to hours

What is the dominant syndrome and the typical onset of the GI irritant group of mushrooms?

coolcholinergic, 5-30 minutes

What is the dominant syndrome and the typical onset of the muscarine group of mushrooms?

CNS, 30 minutes - 2 hours

What is the dominant syndrome and the typical onset of the Ibotenic acid/muscimol group of mushrooms?

CNS/behavior, rapid

What is the dominant syndrome and the typical onset of the Psilocybin/psilocin group of mushrooms?

GI+CNS+liver/RBC, hours

What is the dominant syndrome and the typical onset of the gyromitrin/MMH group of mushrooms?

GI, liver and/or kidney, 6-24 hours GI

What is the dominant syndrome and the typical onset of the Amanitins group of mushrooms?

most mushrooms cause GI issues, we have to prove that this is ONLY GI issues

What is the difficulty in proving that the mushroom eaten is a GI irritant mushroom?

SLUDD signs, vomiting, bloody diarrhea, lethargy, dehydration,

What are the signs of GI irritant mushrooms?

mostly unknown (local irritation, hypersensitivty, enzyme related maybe)

What is the mechanism of action of a GI irritant mushroom?

decontamination (vomit), fluids, GI support, electrolytes, acid/base support,

What is the management you look to if there is exposure to GI irritant muchrooms

If the GI signs started 6-24 hours after exposure

If you suspect GI irritant mushrooms have been eaten.... what symptom is a big red flag that you're actually wrong?

(BESIDES any type of neuro sign)

amanitin

If you suspect GI irritant mushrooms have been eaten.... which group of mushrooms is more likely if the symptoms dont start until 6-24 hours after exposure?

muscarine

which mushroom type leads to 'pure peripheral cholinergic excess?'

muscarinic ACh, parasympathetic stimulation

muscarine type mushrooms have toxin that acts on which receptors?

And this causes what to be prolonged?

glands, cardiac nodal tissue, smooth muscle

What organs/body systems need to be monitored if there is muscarine mushroom exposure?

salivation, lacrimation, vomiting, diarrhea

What do glands do under the influence of muscarine mushrooms?

hypotension rate/rhythm effects

What effect does muscarine mushrooms have on cardiac nodal tissues?

bronchoconstriction, GI/GU motility

What effects do muscarine mushrooms have on smooth muscle

muscarine does NOT cross the blood brain barrier

What is the KEY distinction of muscarine type mushrooms?

if there are CNS signs, probably something other than muscarine

What does the key distinction of muscarine mushrooms MEAN practically

atropine to effect

What is the antidote to muscarine mushrooms?

irritants to esophagus, aspiration pneumonia

What are the two reasons that you may NOT want to induce vomiting in a small animals?

drying/cessation of excessive secretions (not mydriasis)

When giving atropine to an animal with muscarine exposure , what is the endpoint of therapy that we are looking for?

oxygen, IV fluids, emesis (maybe)

What are additional types of support that an animal exposed to muscarine mushrooms may need?

false; this is a mixed excitation and depression case from ibotenic acid and muscimol

true/false: Amanita muscaria/pantherina is a good example of a muscarine syndrome

psilocybin mushrooms

Which category of mushrooms has effects described as "serotonergic behavioral toxidrome"?

disorientation, agitation, aggression, vocalization, drowsiness (theyre high dude)

What are the behavioral effects of Psilocybin mushrooms?

symptomatic/supportive care

What is the treatment of choice for animals exposed to psilocybin mushrooms

good!

What is the prognosis for animals exposed to psilocybin mushrooms?

pyridoxine, decrease GABA synthesis

false morels act by converting gyromitrin to monomethylhydrazine (MMH) which interferes with __________ dependent pathways, causing what ultimate effect?

GI, CNS, (other is oxidative stress, liver/kidney)

What major systems does MMH and false morel mushrooms target?

vomit, watery diarrhea, abdominal pain, dehydration

What GI signs do false morels cause?

tremors/seizures, hypoglycemia, possible CNS depression

What CNS signs do false morels cause?

supportive care, seizure control, pyroxidine/vit b12

What are the treatments used for animals with false morel exposure?

amanitins

What is THE mushroom exposure that you CANNOT miss

amanita, galerina, lepiota

Which are the three specific Amanitin type mushrooms? (He has these IN RED and specifically said to know them)

heat stable bicyclic octapeptides

What specific type of toxin is in amanitin mushrooms?

hepatocytes (fulminant acute liver failure)

What is the primary target of amanitins?

GI mucosa, proximal renal tubules (acute tubular necrosis)

What are the other two targets of amanitins? (after hepatocytes)

true

true/false: A single death cap/destroying angel may contain lethal concentrations of toxin. These are amanitin mushrooms.

DELAYED SIGNS, originally the patient may look normal

What is the main sign that should make you go "oh... it may be ana amanitin mushroom"?

liver, GI muscosa, kidney proximal tubules

Okay, we already said them, but he said super important so what are the tissues that amanitin mushrooms damage more than others?

rapidly active

What do the main target tissues for amanitin mushrooms have in common?

hepatocytes, RNA polymerase inhibition, decreased mRNA and protein synthesis

Amanitin MOA:

Amanitins is taken up by the ____________________, which then causes _________________ [activation/inhibition]... this ultimately results in [increased/decreased] _______________ and ________________________

He did say - "unfortunately this MOA is important"

hypoglycemia

Severe ___________ is a major prognostic concern in cases of amanitin exposure

false; a false recovery is common at the 12-24 hour mark with amanitins

true/false: If you have exposure to mushrooms that results in GI signs, if you start to see recovery at the end of the first day, it was likely just a small dose and you're probably out of the woods

biochemical and clinical liver failure

If your animal has had aminitin exposure and is in the false recovery window... what happens next?

nah, may be normal

Are early CBC/chem results useful with amanitins? If so, how?

urine! (amanitins excreted largely unchanged)

What sample IS genuinely useful for amanitin testing in a live animal?

72, 24

Urine testing in amanitin exposure is useful up to ______ hours. Serum, is useful up to _______ hours.

GI contents, frozen liver AND kidney, mushroom fragments

If your animal dies... what samples should be saved to determine the type of mushroom exposure?

true

true/false: a negative "quick mushroom test" should not override the clinical picture

decontaminate, perfuse, protect liver, treat failure, escalate

What are the five steps in order of amanitin treatment?

activated charcoal, IV fluids, IV silibinin, dextrose vitamin K, time sensitive advanced liver support

Give one example of each of the amanitin treatment steps:

(Decontaminate, perfuse, protect liver, treat failure, escalate)

My answers are in THAT order

supportive care

If you dont know what mushroom was ingested and your patient has early GI signs.... what do you do?

atropine and support

If you dont know what mushroom was ingested and your patient has SLUDD signs.... what do you do?

quiet area, monitor temperature, seizure care

If you dont know what mushroom was ingested and your patient has Neuro signs.... what do you do?

assume hepatotoxic risk, monitor liver/kidney/glucose/coag CLOSELY

If you dont know what mushroom was ingested and your patient has delayed GI signs OR unknown signs.... what do you do?

amanitins

A 14 kg dog is seen after a suspescted backyard mushroom ingestion. He was normal for around 8 hours, then developed vomiting and diarrhea. By the next morning the GI signs are improving...

What toxidrome should be highest on your list?

glucose, coag, liver enzymes

A 14 kg dog is seen after a suspescted backyard mushroom ingestion. He was normal for around 8 hours, then developed vomiting and diarrhea. By the next morning the GI signs are improving...

What laboratory trends matter most over the next 24-48 hours?

no! False recovery!

A 14 kg dog is seen after a suspescted backyard mushroom ingestion. He was normal for around 8 hours, then developed vomiting and diarrhea. By the next morning the GI signs are improving...

Would "he looks better" reassure you?

source, safety claim

The term "natural" is a ________ not a __________

volatile oils, resins, alkaloids, glycosides, fixed oils

Give me some examples of Natural whole-plant products

true

true/false: when a client says they use something natural... ask to see the actual bottle, label, ingredient list and lot, not just for the product name

5-HTP (5-hydrocytryptophan)

What supplement used in humans to regulate sleep and appetite will cause seizures, tremors, ataxia, depression, hyperthermia, and vomiting/diarrhea in dogs

serotonin toxicity in the CNS

What does exposure to 5-HTP cause? (mechanism, not specific signs)

ephedra/ma huang

What 'herbal weight loss' product causes ephedrine and pseudoephedrine increases and sympathomimetic effects in dogs

-this means restlessness, techycardia/arrythmias, hyperthermia, tremors/seizures

guarana

Which 'herbal weight loss' product is a caffeine rich plant that adds methylcanthine stimulation

hyperactivity, tremors, seizure, emesis, tachycardia, hyperthermia, mortality 17%

Combinations of ephedra (sypathiomimetic) and guarana (methylxanthine) products will lead to what signs in dogs?

platelet inhibition, increased firbinolytic activity, GI irritation, anemia,

What effects does garlic have on dogs? (garlic and its extracts/oils)

hemoglobin is very susceptible to oxidative damage, HEINZ BODY ANEMIA

What is a specific concern in cats with garlic exposure? Why?

cardiac glycosides

What are digitalis and oleander? (what toxic category of plant)

NA/K ATPase

Cardiac glycosides work by inhibiting _______________

increase, increase

Cardiac glycosides [increase/decrease] intracellular Na, and [increase/decrease] intracellular Ca

oleander

Wait, which plant was a cardiac glycoside plant? (specifically which did he say should be treated as an emergency if ingested)

true

true/false: comfrey, chaparral, kava kava and pennyroyal oil are all topical hepatotoxic herbs that can be harmful (and that he told us not to worry about specifics on, just to be aware of)

orally, AND through skin

Volatile oils can be absorbed both _______ AND _________

remove source, BATHE THE ANIMAL, then supportive care

What are the first steps in treating an animal with toxic exposure to essential or volatile oils?

ataxia, depression, tremors, hypothermia

What are the three effects of tea tree oil on dogs

(said he's gonna ask us a 'which of these doesn't belong' type question)

true

true/false: "a few drops" can still be a meaningful exposure when a product is heavily concentrated

what is the EXACT product

A cat presents with hypothermia, ataxia, weakness, and tremors. The owner applied a concentrated 'natural' flea product to the coat 8 hours ago.

Priority one is to answer which exposure question immediately?

BATHE THE PATIENT

A cat presents with hypothermia, ataxia, weakness, and tremors. The owner applied a concentrated 'natural' flea product to the coat 8 hours ago.

Priority number TWO is which decontamination step?

CNS, temperature, liver

A cat presents with hypothermia, ataxia, weakness, and tremors. The owner applied a concentrated 'natural' flea product to the coat 8 hours ago.

Priority number THREE is to monitor which systems?

cool

Heres our last wrap up slide.

Cool?