Analysis of mushroom poisoning cases admitted to Duzce University school of Medicine Emergency Department

Background and Objectives: Approximately 5000 mushroom species have been defined in the world, of which about 100 have been found to be poisonous. Among these, approximately 10 species are known to cause lethal poisoning. Among the poisonous mushrooms, Amanita phalloides is the best known. Many toxins have been identified in this mushroom. In general, these toxins are divided into 2 classes as amanitines (amatoxins, amanotoxins) and fallotoxins. According to the National Poison Information Center 2008 data, food-borne intoxications account for 3.3% of all intoxications and fungal intoxications account for 43.5% of food-borne intoxications. Mushroom poisonings constitute 50% of the deaths caused by plant-based poisonings. Because of the abundant rainfall, lots of mushroom species grow in Duzce province, and it is commonly seen that people admit to emergency departments with complaints which may be related to mushroom intake. In this study, it is aimed to be able to help the emergency physician in the process of diagnosis, treatment, follow-up and prediction of prognosis in daily emergency medicine practice in the light of the data obtained by examining the demographic, clinical and laboratory characteristics of 33 patients who bacame ill and applied to our emergency department after eating mushrooms. Materials and Methods: In this study, a total number of 33 patients who are over 18 and applied to Düzce University Hospital Emergency Department due to the development of signs and symptoms after mushroom intake between the dates 01.09.2015 and 06.06.2016 vi were included. 33 cases without any history of recent mushroom intake were included as the control group. Our study was designed as a prospective case control study. The demographic characteristics of the patients, presenting symptoms, how long ago they consumed mushrooms, the emergency follow-up process and the treatments given were evaluated. Baseline biochemical parameters were examined in venous blood samples taken from patients. In addition, the level of alpha amanitin in serum and urine taken from the patients was also studied with ELISA using the standard method specified by the producer of the kit. Statistical evaluations were performed in the Statistical Package for the Social Science (SPSS v22) program. Results: Alpha amanitin was not detected in blood and urine samples taken from neither the study nor the control group. The male to female ratio was 5/6. The median age of the patients was 50 years (range 20 to 80). The most common symptoms were nausea (94%) and vomiting (85%). Mean of the time period between mushroom intake and emergency department application was 11 (min: 2 - max: 25) hours. Sixty seven percent (n= 22) of the patients in the study group had gastric lavage and 88% (n= 29) of them were given active charcoal. All of the patients were given intravenous fluid therapy. Seventy five point eight percent (n= 25) of the patients were discharged from the emergency department and 24.2% (n= 8) were hospitalized. Conclusion: This study will provide scientists with some useful information about mushroom poisonings that can lead to serious complications or even death when they can not be diagnosed promptly. When a patient presented to the emergency department because of nausea and vomiting, any history of recent mushroom intake must be questioned by the emergency physician. Poisoning due to consumption of mushrooms is very common in Western Black Sea Region. Particularly in rural areas, the population of the region should be trained because of the frequency of poisoning incidents due to the consumption of wild mushrooms collected from nature. Public health units should take protective measures against wild mushrooms which are sold at markets without any control. Training of health professionals on mushroom poisoning will be vii useful in patient management. Mushroom poisoning is a preventable health problem and a cause of death. Community awareness on avoiding comsumption of the mushrooms collected from nature should be raised in order to reduce the number of applications to health facilities due to mushroom poisoning and to alleviate the burden on the health system and to reduce mortality. Keywords: Mushroom poisoning, alpha amanitin, Amanita phalloides.