With the arrival of autumn and the mushroom season, emergency room visits for poisoning increase. Most cases are mild, but a small fraction are caused by mushrooms containing amatoxins, toxins that damage the liver and are responsible for the vast majority of deaths from mushroom consumption. These hepatotoxic substances are found in species such as the death cap (Amanita phalloides), the destroying angel (A. verna, A. virosa), some small lepiotas, and Galerina marginata. They are heat-resistant, meaning they are not destroyed by cooking, freezing, or drying the mushrooms, and the first symptoms take between 6 and 24 hours to appear.
The Clínic has a clinical toxicology circuit to address potential mushroom poisonings and a reference laboratory for analyzing urinary amatoxins, receiving samples from hospitals across Catalonia and operating 24/7.
“"The major challenge with these poisonings is that by the time a patient arrives at the emergency room with vomiting and diarrhea, the toxin has already been acting for hours. Identifying cases with a high suspicion of amatoxin poisoning and confirming their presence quickly allows us to act more safely."
The clinical toxicology protocol operates multidisciplinarily. It begins with the onset of digestive symptoms (nausea, vomiting, diarrhea, or abdominal discomfort) after consuming mushrooms. In the Emergency Department, screening involves key questions about the source, timing of consumption, preparation, quantity, and number of people affected. If amatoxin poisoning is suspected, urgent urinary amatoxin determination is requested. Upon confirmation, blood is drawn to assess general function (liver, kidney, coagulation), and urine is tested for amatoxins. Treatment (digestive decontamination, intensive hydration, and antidotal therapy) begins immediately, without waiting for results. The analysis confirms or rules out poisoning and, along with liver function monitoring, helps stratify the patient and establish their prognosis. In severe cases, the patient is evaluated with the Liver Transplant Unit.
For healthcare professionals, screening is crucial: it's necessary to actively inquire about wild mushroom consumption in the preceding days. A latency period of over 6 hours between ingestion and symptom onset warrants suspicion of amatoxin poisoning. Beware of false recovery, as liver damage can progress. Amatoxins are primarily excreted in urine, so samples should be collected as soon as possible. A late negative result does not rule out poisoning, and a positive result confirms exposure but doesn't replace clinical or analytical monitoring. Treatment should not be delayed.
Healthcare professionals with doubts can consult the Toxicological Information Service of the National Institute of Toxicology and Forensic Sciences (Madrid) at +34 91 562 04 20, available 24 hours a day.
