To the Editor.—
The review of mush-room poisoning by Hanrahan and Gordon1 provides a timely reminder that foraging in the wild for food and fun can be extremely dangerous. Those bent on finding wild mushrooms for the dinner table are well advised to do so only in the company of an experienced mycologist.We would like to disagree with some of the authors' advice on diagnosis and treatment of amatoxin poisoning. Their treatment algorithm implies that patients with early-onset symptoms do not have amatoxin poisoning and also recommends a "grab bag" of unproved antidotes.It is true that if the onset of gastrointestinal (GI) symptoms is delayed by more than six to eight hours, ingestion of amatoxin is likely. However, the early onset of symptoms due to poisoning by a simple GI tract irritant, such as Entoloma lividum, does not rule out concomitant ingestion of an amatoxin-containing mushroom. Frequently
Olson KR, Woo OF, Pond SM. Treatment of Mushroom Poisoning. JAMA. 1984;252(22):3130–3131. doi:10.1001/jama.1984.03350220038022
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