Stomate syndrome is a set of symptoms that appears after poisoning with amanitins - toxins contained, among others, in in the toadstool. The severity of symptoms and the course of intoxication depend on many factors, mainly on the absorbed dose of amanitine. What are the symptoms of stinkhorn syndrome? What is the treatment?

Contents:

  1. Stamotor syndrome - causes
  2. Stimulating syndrome - symptoms
  3. Stimulator syndrome - diagnostics
  4. Stimulator syndrome - treatment
  5. Stimulator syndrome - death

The stonewall syndromedevelops after eating mushrooms, which contain a toxin called amanitin. They occur in fungi of the fly agaric family, which include, among others, toadstool, as well as some tops and helmets.

Most often they are eaten by mistake because they are confused with edible mushrooms (e.g. goose green, kite tops, mushrooms).

Stamotor syndrome - causes

Mushrooms from the fly agaric family contain two basic groups of toxic substances, which are divided into phallotoxins and amatoxins. Phalotoxins include phaloidin, phaloin, phalocidin, phalosin, and phalin B.

The group of amatoxins includes alpha-, beta-, gamma-, delta and epsylone-amanitin. Chemically, they are cyclic peptides (cyclopeptides). The main difference between these two groups of toxins is the mechanism and speed of the toxic action.

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100 g of fresh toadstool contains approx. 10 mg of phaloidin, 8 mg of alpha-amanitine and 5 mg of bata-amanitin. And the lethal dose for humans is less than 0.1 mg of amanitine for every kilogram of body weight.

Amatoxins are resistant to drying, thermal treatment and are resistant to the action of digestive enzymes. In the body, they combine with albumin to form specific complexes, the toxicity of which is 10 times greater than that of the amatoxins themselves.

These toxins are not evenly distributed in the mushroom. It is estimated that the hat contains approx. 70% of toxic cyclopeptides, 46% of which are in the gills, while the body contains approx. 23% .¹

Stimulating syndrome - symptoms

There are four phases in the stomata syndrome: asymptomatic,intestinal, hepatic and cerebral .¹

1. Asymptomatic phase

Usually takes 8 to 24 hours from the time you eat the mushrooms.

2. Intestinal phase

there are gastrointestinal symptoms such as:

  • nausea
  • vomiting
  • profuse and watery diarrhea

They lead to dehydration and electrolyte disturbances.

This phase is especially dangerous in the case of children, the elderly, and stressed patients who have problems with the circulatory system and kidneys.

Each toadstool poisoning may proceed in a different way.

It lasts for about 1-3 days, then there is a period of apparent improvement and the disappearance or alleviation of the ailments.

3. Liver phase

The hepatic phase begins after another 3-5 days.

This period is characterized by symptoms of hepatocyte (liver cell) damage and liver dysfunction, such as

  • worsening of diarrhea, often with some blood
  • liver enlargement or rapid decrease (acute liver atrophy). Besides, it is tender, soft
  • stomach ache when touching it
  • jaundice
  • disturbance of consciousness and hepatic coma (appear in severe course)

You can observe features of a hemorrhagic diathesis, i.e. bleeding from injection sites, epistaxis, haematuria, gastrointestinal bleeding, and in severe forms, intravascular coagulation syndrome.

In addition, there is a deterioration in kidney function (which is manifested by oliguria or anuria), hypoglycaemia and metabolic acidosis.

4. Brain phase

Occurs 5-7 days after poisoning.

The following appears then:

  • sleepiness
  • confusion
  • disturbance of consciousness
  • neuroglycopenia - is a group of neurological disorders resulting from hypoglycemia, i.e. a state of low blood glucose levels
  • thermoregulation disorders leading to hyperthermia

The expression of severe damage to the central nervous system is

  • convulsions
  • breathing disorders
  • apnea

Stimulator syndrome - diagnostics

At the beginning, determine the type and amount of mushrooms consumed, the method of their preparation (whole caps, chopped mushrooms, etc.), the time that will elapse from the consumption of mushrooms to the appearance of the first symptoms, the number of people who ate a given meal, etc. .

Then blood and urine tests are done to confirm poisoning. It should be noted, however, that the result was negativedoes not exclude the possibility of poisoning and may result from a late visit to the doctor.

The doctor should also rule out other possible causes, such as infections, dietary mistakes, poisoning with other hepatotoxic substances, and hepatitis.

Stimulator syndrome - treatment

To remove toxins from the body, use: ¹

  • provoking vomiting
  • gastric and intestinal lavage
  • probing and suction of duodenal content
  • laxatives and adsorbents
  • forced diuresis

Gastric lavage is performed up to an hour after eating a dish with poisonous mushrooms, but due to the fact that they are difficult to digest, many authors recommend performing this procedure up to several hours from the time of possible poisoning.

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The administration of activated charcoal should be started after the washings have been taken for a possible sporological examination.

It is also necessary to balance the water and electrolyte balance. Forced diuresis is used, which consists in administering many (>5) liters of fluid per day, with a composition that does not deplete the system in electrolytes

Coagulation parameters should be monitored and if necessary, vitamin K, fresh-frozen plasma, anti-haemophilic plasma or platelet mass should be used.

If renal failure develops, hemodialysis is recommended. For the treatment of acute liver failure in the course of this type of poisoning, in justified cases, surgical methods are also used (e.g. albumin dialysis in the MARS system).

However, in very severe cases, with rapidly increasing symptoms of intoxication and liver failure, the possibility of liver transplantation should be considered.

Worth knowing

Stamotor syndrome - death

The course of poisoning can be mild, only with catarrhal symptoms, up to very severe and irreversible liver damage.

The course and prognosis in stonecrop syndrome depends on many factors, including the amount of fungi consumed, the patient's age, nutritional status, coexistence of chronic diseases, and the time elapsed from the time of intoxication to the initiation of proper treatment.

Severe poisoning has an unfavorable prognosis and in 10 - 60% of cases the patient's death ends within 6 to 16 days.

Bibliography:

Radoniewicz-Tchórz A., Górska A., Majewska M., Zaleski K., Tchórz M., Szponar J., Stinkhorn syndrome in the course of accidental and suicidal toadstool poisoning - a report of two cases, Przegląd Lekarski 2022

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