In mushroom poisoning

States. In Mushroom Poisoning Diagnosis and Treatment, eds. Barry H. Rumack and Emanuell Saltzman, 231—43. 

Some flavonoid glycosides are prepared s)mthetically or by biotransformations, usually for pharmaceutical purposes. Silybin (7) is a flavonolignan that is extracted from seeds of milk thistle (Silybum marianum) and it is used extensively as a potent hepatoprotectant and an antidote in mushroom poisoning. The major drawback of this compound is its low water solubility (about 0.43 g/L). Therefore, its glycosylation was accomplished by biological [13] and chemical methods [14]. 

Burton JR Jr et al Liver transplantation in mushroom poisoning. J Clin Gastroenterol 2002 35(3) 276-280. [PMID 12192208] (Case report and review of criteria for liver transplantation.)... 

The betalains are confined to ten families of the order Caryophyllales20 The only foods containing betalains are red beet (Beta vulgaris), chard (B. vulgaris), cactus fruit (Opuntia ficus-indica) and pokeberries (Phytolacca americana). They also occur in the poisonous mushroom Amanita muscaria but this is not a normal food source. The importance of the betalains as colorants is confined to preparations from red beet. 

This large group of mushrooms accounts by far for the largest number of mushroom poisonings, but fatalities are very rare, possibly absent. In the great majority of cases the toxins involved remain unidentified, and may dilfer from species to species. 

This mushroom is responsible for a significant number of mushroom poisonings in Europe. Symptoms such as vomiting, abdominal pain, and diarrhea may be seen between thirty minutes and two hours after ingestion. No Entoloma poisonings have been fatal and symptoms disappear within a day or two. 

Of all mushroom poisonings in two Swiss studies, 20 to 50% were due to this mushroom. One to two hours postingestion the patient may experience abdominal pain, violent vomiting, sweating, diarrhea, and cramping in the calf muscles. Symptoms usually last for two to six hours, but full recovery may take three to six days. 

Lactarius species are milk -containing mushrooms. Poisonous Lactarius are generally found in species with white latex. After eating large quantities of these mushrooms, symptoms such as vomiting, profuse diarrhea, and sweating will occur fifteen minutes to one hour after the meal. The nature of the toxin is unknown. 

Augenstein, W.L. (1994), Chlorophyllum Molybditis, in Spoerke, D.G. and Rumack, B.H., Eds., Handbook of mushroom poisoning, CRC Press, Boca Raton, chap. 17. 

Benjamin, D.R. (1992). Mushroom poisoning in infants and children The Amanita pantherina/muscaria group, J. Toxicol. Clin. Toxicol., 30, 13-22. 

Chaiear, K., Limpaiboon, R., Meechai, C. and Poovorawan, Y. (1999). Fatal mushroom poisoning caused by Amanita virosa in Thailand, Southeast Asian J. Trop. Med. Public Health, 30, 157-160. 

Faulstich H. and Wieland, T. (1992). Mushroom Poisons, in Tu, A.T., Ed., Food poisoning, Marcel Dekker, New York. 

Mushroom poisoning requires serious medical intervention because muscarine absorbs well in the gastrointestinal tract, and therefore it can lead to death. Muscarine is considerably more powerful than acetylcholine, possibly because of its high stability. Because it is... 

Antidotes for poisoning by cholinergic drugs Atropine is used for poisoning by organophosphorus insecticides, chemical warfare nerve gases, and as an antidote for mushroom poisoning caused by muscarine in certain species, such as Amanita muscaria. 

Intravenous silymarin has been demonstrated to lower mortality from Amanita mushroom poisonings, but this formulation is available only in Europe. Animal studies have demonstrated hepatic protection against alcohol, acetaminophen, and mushroom toxins and protection against hepatic fibrosis with bile duct occlusion. There is also evidence of silybin protecting against cis-platin-induced nephrotoxicity in rats. It is not yet clear whether milk thistle extract offers any renal protection to humans. 

Milk thistle has shown promise in improving liver function parameters in various hepatotoxic situations, such as alcoholic cirrhosis and mushroom poisoning. It is still unclear whether it will offer protection against viral hepatitis and various nephrotoxic agents. 

Delayed-onset mushroom poisoning, usually caused by Amanita phalloides, A virosa, Galerina autumnalis, or G marginata, manifests its first symptoms 6-12 hours after ingestion. Although the initial symptoms usually include nausea and vomiting, the major toxicity involves hepatic and renal cellular injury by amatoxins that inhibit RNA polymerase. Atropine is of no value in this form of mushroom poisoning (see Chapter 58). 

The skin often appears flushed, hot, and dry in poisoning with atropine and other antimuscarinics. Excessive sweating occurs with organophosphates, nicotine, and sympathomimetic drugs. Cyanosis may be caused by hypoxemia or by methemoglobinemia. Icterus may suggest hepatic necrosis due to acetaminophen or Amanita phalloides mushroom poisoning. 

Although milk thistle has not been confirmed as an antidote following acute exposure to liver toxins in humans, parenteral silybin is nevertheless marketed and used in Europe as an antidote in Amanita phalloides mushroom poisoning. This use is based on favorable outcomes reported in case-control studies. 

Other species of amanita are among the deadliest fungi known. Polypeptide-like toxins in Amanita phalloides, or death cup, can prove fatal or at the very least can cause permanent liver and kidney damage. These mushrooms are common in the temperate climates of Europe and North America. They are responsible for the majority of what is called "slow" mushroom poisoning in the U.S. In fact, it was only a few years ago that the local newspaper reported a case of amanita poisoning within SLO county. Mushroom poisoning is known as mycetism. In addition the amanita also contain bufotenine which has CNS effects. See the ASIDE which discusses the peptide poisons. 

What is most remarkable is that cells can produce proteins with strikingly different properties and activities by joining the same 20 amino acids in many different combinations and sequences. From these building blocks different organisms can make such widely diverse products as enzymes, hormones, antibodies, transporters, muscle fibers, the lens protein of the eye, feathers, spider webs, rhinoceros horn, milk proteins, antibiotics, mushroom poisons, and myriad other substances having distinct biological activities (Fig. 3-1). Among these protein products, the enzymes are the most varied and specialized. Virtually all cellular reactions are catalyzed by enzymes. 

Many small peptides exert their effects at very low concentrations. For example, a number of vertebrate hormones (Chapter 23) are small peptides. These include oxytocin (nine amino acid residues), which is secreted by the posterior pituitary and stimulates uterine contractions bradykinin (nine residues), which inhibits inflammation of tissues and thyrotropin-releasing factor (three residues), which is formed in the hypothalamus and stimulates the release of another hormone, thyrotropin, from the anterior pituitary gland. Some extremely toxic mushroom poisons, such as amanitin, are also small peptides, as are many antibiotics. 

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