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Pilzvergiftungen: Toxidrome, Diagnose und Therapie

Mushroom poisonings: Syndromic diagnosis and treatment

Summary

The major syndromes of mushroom poisoning can be divided by presentation timing: Early syndromes (symptom onset < 6 hrs after ingestion) have little probability to cause organ damage. Epigastric pain, nausea, vomiting and diarrhea occur in most cases and treatment includes initial gastrointestinal decontamination with oral activated charcoal and fluid rehydration. In addition, an acute gastrointestinal syndrome can be combined with cholinergic toxicity, epileptiformic response or immunohemolytic anemia. Neurotoxic Syndromes may present as dysphoria, delirium, hallucinations or disulfiram-like reactions. Treatment is entirely supportive and if performed in hospital, the prognosis is good. Late syndromes (symptom onset > 6 hrs after ingestion) are life-threatening due to liver- and renal failure. Patients who are jaundiced after an acute gastrointestinal episode, are suspected to be poisoned with Amatoxins. Patiens with flank pain, hematuria, polyuria or oliguria in the absence of jaundice are suspected to have an intoxication with Cortinarius mushrooms. In both cases an intensive care management is indicated.

Zusammenfassung

Pilzvergiftungen sind in der Regel nicht organschädigend, wenn Krankheitssymptome nach der Mahlzeit rasch, innerhalb von 6 Stunden auftreten. Mit einem isolierten Brechdurchfall ist bei der Mehrzahl dieser Intoxikationen zu rechnen und die Gabe von Medizinalkohle ist zur Verminderung der intestinalen Gift-resorption gerechtfertigt. Ein akutes Abdomen kann jedoch auch mit einer cholinergen Reaktion, einem epileptiformen Syndrom oder einer Immunhämolyse kombiniert sein. Die Therapie ist supportiv und konzentriert sich primär auf den Ersatz der gastrointestinalen Elektrolyt- und Flüssigkeitsverluste. Neurotoxische Syndrome inkludieren Rauschzustände, Halluzinationen und Alkoholunverträglichkeitsreaktionen. Die Behandlung ist symptomatisch und sollte ausnahmslos stationär erfolgen, bis die Symptome vollständig abgeklungen sind. Dann ist die Prognose gut. Treten Beschwerden nach einer längeren Latenzzeit als 6 Stunden auf, besteht Lebensgefahr infolge Leberund Nierenversagens. Nach Brechdurchfällen weist eine Gelbsucht auf Knollenblätterpilzvergiftung hin, während bei fehlendem Ikterus Nierenschmerzen, blutiger Urin, Harnflut oder Harnverhalten eine Intoxikation mit Haarschleierlingen wahrscheinlich machen. In beiden Fällen ist eine intensivmedizinische Behandlung unabdingbar.

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Correspondence to Peter Kaufmann.

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Kaufmann, P. Pilzvergiftungen: Toxidrome, Diagnose und Therapie. Wien Med Wochenschr 157, 493–502 (2007). https://doi.org/10.1007/s10354-007-0465-z

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Keywords

  • Poisonous mushrooms
  • Poisonous fungi
  • Food poisoning
  • Toxidrome
  • Amatoxins

Schlüsselwörter

  • Giftpilze
  • Pilze
  • Toxidrome
  • Verdorbene Nahrungsmittel
  • Amatoxine