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From the Centers for Disease Control and Prevention. Amanita phalloides mushroom poisoning--northern California, January 1997.

Mushroom Poisoning — Continued The popular interest in gathering and eating uncultivated mushrooms has been associated with an increase in incidents of serious mushroom-related poisonings (1 ). From December 28, 1996, through January 6, 1997, nine persons in northern California required hospitalization after eating Amanita phalloides (i.e., “death cap”) mushrooms; two of these persons died. Risks associated with eating these mushrooms result from a potent hepatotoxin. This report describes four cases of A. phalloides poisoning in patients admitted to a regional referral hospital in northern California during January 1997 and underscores that wild mushrooms should not be eaten unless identified as nonpoisonous by a mushroom expert. Case 1. A 32-year-old man gathered and ate wild mushrooms that he believed were similar to other mushrooms he had previously gathered and eaten. Eight hours later, he developed vomiting and profuse diarrhea; he was admitted to a hospital 19 hours after ingestion. On admission, he was dehydrated, and laboratory findings included an aspartate aminotransferase (AST) level of 81 U/L (normal: 0–48 U/L), prothrombin time (PT) of 12.3 seconds (normal: 11.0–12.8 seconds), and bilirubin level of 0.9 mg/dL (normal: 0–0.3 mg/dL). He received intravenous fluids, intravenous penicillin, repeated oral doses of activated charcoal, and oral N-acetylcysteine. Although the diarrhea resolved after 24 hours, his PT and AST and bilirubin levels continued to rise. On the third day after eating the mushrooms, abnormal findings included an AST level of 2400 U/L, alanine aminotransferase (ALT) level of 4100 U/L (normal: 0–53 U/L), PT of >60 seconds, and total bilirubin level of 11 mg/dL. Six days after eating the mushrooms, his bilirubin level was 16 mg/dL, and his AST level had decreased to 355 U/L; he developed metabolic acidosis and hypotension. Seven days after eating the mushrooms, he developed hepatic encephalopathy, oliguric renal failure, and adult respiratory distress syndrome requiring intubation and mechanical ventilation. He died from multiple organ failure 9 days after eating the mushrooms. One mushroom cap remaining after the meal was identified as A. phalloides. Case 2. A 42-year-old man developed vomiting and diarrhea 11 hours after eating wild mushrooms, and he was admitted to a hospital 14 hours after eating the mushrooms. His transaminase levels were elevated 24 hours after ingestion (AST and ALT levels both at 100 U/L); his PT was 12.1 seconds, and his bilirubin level was 0.2 mg/dL. His PT became prolonged the next day and peaked at 35 seconds on the fourth day.