A 10-year retrospective analysis of mushroom poisoning cases admitted to the Emergency Department of Çukurova University

ABSTRACT A 10-Year Retrospective Analysis of Mushroom Poisoning Cases Admitted to the Emergency Department of Çukurova University Aim: Although mushrooms are consumed as food, certain species can have toxic effects that may lead to serious health problems or even death. The ease with which wild mushrooms can be mistaken for poisonous varieties poses a significant public health risk. Diagnosis is generally challenging, and no standardized treatment protocol has yet been established. This study aimed to conduct a regional evaluation by examining the possible mushroom species responsible for poisonings in the Eastern Mediterranean Region, their associated clinical presentations, and the demographic and laboratory findings of the patients. The findings are intended to contribute to the improvement of healthcare services in the region. Materials and Methods: This retrospective study was conducted with the approval of the Non-Interventional Clinical Research Ethics Committee of Çukurova University Faculty of Medicine. It included patients over the age of 18 who presented to our emergency department between January 2015 and December 2024 with clinical signs of poisoning after consuming wild mushrooms. Patient files were reviewed, and data were collected on demographics, information about the consumed mushrooms, possible species identification based on clinical findings, laboratory results, antidotes used during treatment, extracorporeal methods, and complications. The clinical course and patient outcomes were statistically analyzed. The possible mushroom species responsible for the poisonings were classified and presented in table format. Results: The study included 218 patients, with a mean age of 46 ± 16 years; 55.5% were female. A total of 37.2% of the cases presented during the winter season. The majority of admissions were from Adana province (88.1%), particularly from the Kozan district (22.0%). While 53.2% of the patients presented directly to the emergency department, 46.8% were referred from other healthcare facilities. The average symptom onset time was 5.2 hours. The most common complaints were nausea and vomiting (82.1%). The most frequently administered treatment was hydration (99.5%), while specific antidotes such as N-acetylcysteine (12.8%) and Silibinin (4.6%) were also commonly used. Silibinin was given to 10 patients who developed acute liver injury, and recovery was observed in 90% of them. The average length of hospital stay was 2.24 days. The complication rate was 10.1%, with liver involvement (5.5%), neurological symptoms (2.3%), and kidney involvement (1.4%) being the most common systemic effects. The mortality rate was found to be 1.4%. The need for intensive care was significantly higher in patients aged 65 and older (p=0.011), whereas the hospital stay was shorter in the 18–45 age group (p=0.014). Additionally, a significant association was found between being referred from another facility and the development of complications (p<0.001). Furthermore, for the first time in our region, a classification of possible mushroom species was conducted. Among the 18 cases with severe toxicity, the majority were identified as likely exposed to the Amatoxin group (55.5%), and these patients showed higher rates of organ failure and mortality. Conclusion: In our region, based on the classification according to possible species identification, 55.5% of severe cases were attributed to mushrooms containing amatoxins. However, a wide variety of mushroom species were found to be responsible for poisonings. Silibinin was identified as the preferred antidote in cases of acute liver injury and failure. Although statistical analysis could not be performed due to the low number of cases, high recovery rates were observed. In the Eastern Mediterranean Region, especially in rural areas, the consumption of wild-collected mushrooms is common, causing a significant public health risk. Therefore, preventive measures should be taken, and public awareness should be increased. Additionally, educating healthcare professionals about diagnosis, treatment, and toxicology will enhance patient management. Keywords: Emergency department, mushroom poisoning, acute toxic hepatitis, amatoxin, silibinin