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mushroom poisoning. A late onset of gastric cramping and vomiting may be a more
serious prognostic indicator than early onset of symptoms. Almost none of the mushroom
toxins are changed by heat or drying. Therefore, cooking the plants does not remove the
danger and toxicity can occur from inhalation of mushroom fumes as well as from
ingestion.
Treatment: Treatment in the field is, of necessity, limited because the diagnosis may be
uncertain and the appropriate therapeutic agents such as activated charcoal are rarely,
if ever, included in a first-aid kit. It should be noted that while activated charcoal is
widely used as first-line treatment, there are surprisingly no good randomized double-
blinded studies to support it as the standard of care for toxin ingestion (Bradberry SM,
Vale JA. Multiple-dose activated charcoal: a review of relevant clinical studies. J Toxicol
Clin Toxicol 33:407-416, 1995; Manoguerra AS. Gastrointestinal decontamination after
poisoning. Where is the science? Crit Care Clin 13:709-725, 1997).
If vomiting can be induced within the first few minutes after ingestion, in an alert
patient, some benefit may be achieved. The induction of vomiting after 30 minutes is of
no benefit.
All victims of known, or suspected, toxic ingestion should be evacuated as rapidly
as possible. If the victim develops seizures, benzodiazepines may be helpful for their
control. An unconscious patient must be checked frequently to maintain and protect the
airway that may become compromised by excessive salivation or secretions.
IV. CONTROVERSIES
Is vomiting a beneficial reflex? Should syrup of ipecac be administered in the treatment
of poisoning? A position statement by the American Academy of Clinical Toxicology
and the European Association of Poisons Centres and Clinical Toxicologists (1997)
indicates that there was insufficient data to support or exclude ipecac administration soon
after poison ingestion. The above position statement advises against the routine use of
syrup of ipecac in the management of poisoned patients.
