To the Editor.—
In their review of the treatment of mushroom poisoning, Hanrahan and Gordon recommend high doses of pyridoxine hydrochloride (25 mg/kg, up to a total daily dosage of 15 to 20 g) for neurological symptoms. Before one follows this recommendation, which is to be found in several standard books also, one should remember that pyridoxine can produce untoward neurological effects, particularly in high doses. In protective doses, pyridoxine activates not only the decarboxylation of glutamic acid, with a formation of γ-aminobutyric acid (GABA) and an increase of the GABA content of the brain (this effect is anticonvulsant in the presence of excess isoniazid or its hydrazones) but also, and to a greater extent, the transamination between GABA and α-ketoglutaric acid, leading to the disappearance of GABA and thus to a decrease in the GABA content of the brain.1 High doses of pyridoxine as those recommended by Hanrahan
Clara F. Treatment of Mushroom Poisoning. JAMA. 1984;252(22):3131. doi:10.1001/jama.1984.03350220038023
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