Psilocybe and others
| 1. NAME |
| 1.1 Scientific name |
| 1.2 Family |
| 1.3 Common name(s) and synonym(s) |
| 2. SUMMARY |
| 2.1 Main risks and target organs |
| 2.2 Summary of clinical effects |
| 2.3 Diagnosis |
| 2.4 First aid measures and management principles |
| 2.5 Poisonous parts |
| 2.6 Main toxins |
| 3. CHARACTERISTICS |
| 3.1 Description of the fungus |
| 3.1.1 Special identification features |
| 3.1.2 Habitat |
| 3.1.3 Distribution |
| 3.2 Poisonous parts of the fungus |
| 3.3 The toxin(s) |
| 3.3.1 Name(s) |
| 3.3.2 Description, chemical structure, stability |
| 3.3.3 Other physico-chemical characteristics |
| 3.4 Other chemical contents of the fungus |
| 4. USES/CIRCUMSTANCES OF POISONING |
| 4.1 Uses |
| 4.1.1 Uses |
| 4.1.2 Description |
| 4.2 High risk circumstances |
| 4.3 High risk geographical areas |
| 5. ROUTES OF EXPOSURE |
| 5.1 Oral |
| 5.2 Inhalation |
| 5.3 Dermal |
| 5.4 Eye |
| 5.5 Parenteral |
| 5.6 Others |
| 6. KINETICS |
| 6.1 Absorption by route of exposure |
| 6.2 Distribution by route of exposure |
| 6.3 Biological halflife by route of exposure |
| 6.4 Metabolism |
| 6.5 Elimination and excretion |
| 7. TOXINOLOGY |
| 7.1 Mode of action |
| 7.2 Toxicity |
| 7.2.1 Human data |
| 7.2.1.1 Adults |
| 7.2.1.2 Children |
| 7.2.2 Relevant Animal data |
| 7.2.3 Relevant in vitro data |
| 7.3 Carcinogenicity |
| 7.4 Teratogenicity |
| 7.5 Mutagenicity |
| 7.6 Interactions |
| 8. TOXICOLOGICAL ANALYSES AND BIOMEDICAL INVESTIGATIONS |
| 8.1 Material sampling plan |
| 8.1.1 Sampling and specimen collection |
| 8.1.1.1 Toxicological analyses |
| 8.1.1.2 Biomedical analyses |
| 8.1.1.3 Arterial blood gas analysis |
| 8.1.1.4 Haematological analyses |
| 8.1.1.5 Other (unspecified) analyses |
| 8.1.2 Storage of laboratory samples and specimens |
| 8.1.2.1 Toxicological analyses |
| 8.1.2.2 Biomedical analyses |
| 8.1.2.3 Arterial blood gas analysis |
| 8.1.2.4 Haematological analyses |
| 8.1.2.5 Other (unspecified) analyses |
| 8.1.3 Transport of laboratory samples and specimens |
| 8.1.3.1 Toxicological analyses |
| 8.1.3.2 Biomedical analyses |
| 8.1.3.3 Arterial blood gas analysis |
| 8.1.3.4 Haematological analyses |
| 8.1.3.5 Other (unspecified) analyses |
| 8.2 Toxicological Analyses and Their Interpretation |
| 8.2.1 Tests on toxic ingredient(s) of material |
| 8.2.1.1 Simple Qualitative Test(s) |
| 8.2.1.2 Advanced Qualitative Confirmation Test(s) |
| 8.2.1.3 Simple Quantitative Method(s) |
| 8.2.1.4 Advanced Quantitative Method(s) |
| 8.2.2 Tests for biological specimens |
| 8.2.2.1 Simple Qualitative Test(s) |
| 8.2.2.2 Advanced Qualitative Confirmation Test(s) |
| 8.2.2.3 Simple Quantitative Method(s) |
| 8.2.2.4 Advanced Quantitative Method(s) |
| 8.2.2.5 Other Dedicated Method(s) |
| 8.2.3 Interpretation of toxicological analyses |
| 8.3 Biomedical investigations and their interpretation |
| 8.3.1 Biochemical analysis |
| 8.3.1.1 Blood, plasma or serum |
| 8.3.1.2 Urine |
| 8.3.1.3 Other fluids |
| 8.3.2 Arterial blood gas analyses |
| 8.3.3 Haematological analyse |
| 8.3.4 Interpretation of biomedical investigations |
| 8.4 Other biomedical (diagnostic) investigations and their interpretation |
| 8.5 Overall interpretation of all toxicological analyses and toxicological investigations |
| 8.6 References |
| 9. CLINICAL EFFECTS |
| 9.1 Acute poisoning |
| 9.1.1 Ingestion |
| 9.1.2 Inhalation |
| 9.1.3 Skin exposure |
| 9.1.4 Eye contact |
| 9.1.5 Parenteral exposure |
| 9.1.6 Other |
| 9.2 Chronic poisoning |
| 9.2.1 Ingestion |
| 9.2.2 Inhalation |
| 9.2.3 Skin exposure |
| 9.2.4 Eye contact |
| 9.2.5 Parenteral exposure |
| 9.2.6 Other |
| 9.3 Course, prognosis, cause of death |
| 9.4 Systematic description of clinical effects |
| 9.4.1 Cardiovascular |
| 9.4.2 Respiratory |
| 9.4.3 Neurological |
| 9.4.3.1 Central nervous system (CNS) |
| 9.4.3.2 Peripheral nervous system |
| 9.4.3.3 Autonomic nervous system |
| 9.4.3.4 Skeletal and smooth muscle |
| 9.4.4 Gastrointestinal |
| 9.4.5 Hepatic |
| 9.4.6 Urinary |
| 9.4.6.1 Renal |
| 9.4.6.2 Other |
| 9.4.7 Endocrine and reproductive systems |
| 9.4.8 Dermatological |
| 9.4.9 Eye, ear, nose, throat: local effects |
| 9.4.10 Haematological |
| 9.4.11 Immunological |
| 9.4.12 Metabolic |
| 9.4.12.1 Acid-base disturbances |
| 9.4.12.2 Fluid and electrolyte disturbances |
| 9.4.12.3 Others |
| 9.4.13 Allergic reactions |
| 9.4.14 Other clinical effects |
| 9.4.15 Special risks |
| 9.5 Other |
| 9.6 Summary |
| 10. MANAGEMENT |
| 10.1 General principles |
| 10.2 Life supportive procedures and symptomatic/specific treatment |
| 10.3 Decontamination |
| 10.4 Enhanced elimination |
| 10.5 Antidote/antitoxin treatment |
| 10.5.1 Adults |
| 10.5.2 Children |
| 10.6 Management discussion |
| 11. ILLUSTRATIVE CASES |
| 11.1 Case reports from literature |
| 12. Additional information |
| 12.1 Specific preventive measures |
| 12.2 Other |
| 13. REFERENCES |
| 14. AUTHOR(S), REVIEWER(S) DATA (INCLUDING EACH UPDATING), COMPLETE ADDRESSES |
PSILOCYBE AND OTHERS
International Programme on Chemical Safety
Poisons Information Monograph (Group monograph) G027
Fungi
Please note that further information on Sections 1, 3 and 8 is
pending.
1. NAME
1.1 Scientific name
The psilocybin-containing species known to cause the
majority of toxic exposures are:
Psilocybe
Panaeolus
Copelandia
Gymnopilus
Pluteus
Conocybe
The main toxin is psilocybin.
1.2 Family
Families: Genera:
Strophariaceae Psilocybe
Coprinaeceae Panaeolus,
Copelandia
Cortinariaceae Gymnopilus
Pluteaceae Pluteus
Bolbitiaceae Conocybe
1.3 Common name(s) and synonym(s)
2. SUMMARY
2.1 Main risks and target organs
The main toxins (psilocybin, psilocin, baeocystin,
norbaeocystin) exert neurotoxic effects similar to those of
LSD. They all have a chemical structure closely related to
serotonin and affect central and probably also peripheral
5-HT receptors, resulting in transient central nervous system
symptoms, e.g. hallucinations, euphoria, anxiety and
agitation.
Recently, the presence of phenylethylamine in Psilocybe
semilanceata has been demonstrated and it is suggested that
unwanted reactions may be ascribed to this substance.
2.2 Summary of clinical effects
The onset of symptoms occur within 20 to 30 (to 60)
minutes. The onset may even be more rapid if the mushrooms
are prepared as a liquid (e.g. tea or soup). A few cases of
intravenous injection of mushroom juice are reported. The
intoxication culminates 1.5 hours after the ingestion and
subsides within 6 to 12 hours.
Central nervous symptoms dominate with visual and auditory
hallucinations. Also tactile hallucinations may occur.
Another common symptom is disturbed sensory perception like
visual distorsions, e.g. heightened awareness of colours and
a sensation of objects changing shape and/or somatic
sensations such as numbness or tingling in the skin. One
case of prolonged (more than 24 hours) unilateral
paraesthesiae affecting face and arm is described. Body
image distorsions, depersonalization, derealization and
altered time and space sense are also frequent phenomena.
Emotional alterations such as euphoria, anxiety, agitation
and panic attacks often occur and the latter reactions are
the most common reasons for seeking medical attention.
Physical injury related to uncontrolled behaviour induced by
agitation and panic poses the greatest risk for the patient.
Somatic signs of intoxication are mydriasis, tachycardia,
hypertension, hyperreflexia, nausea and vomiting. Flushing of
the face may also be seen. Incontinence of urine occurs. One
case of Psilocybe semilanceata intoxication resulting in
seizures, cardiopulmonary arrest and myocardial infarction is
reported. Precordial ST-elevations have been observed in a
young, earlier healthy patient.
Chills, rigors, dyspnea, impaired oxygenation, headache,
arthralgia, myalgia, fever, nausea, vomiting, diarrhoea and
laboratory signs of hepatic and renal abnormalities have
occurred after intravenous exposure.
Delayed reactions (flash-backs) up to 4 months after
ingestion of the mushroom have been reported by several
authors.
End-stage renal failure following confusing toxic fungi
belonging to the genus Cortinarius with psilocybe mushrooms
have occurred.
2.3 Diagnosis
In general the diagnosis can be made on the basis of
history and clinical signs and symptoms.
Macroscopic and/or microscopic (spore identification)
inspection of remaining mushrooms may be helpful in doubtful
cases. Spores may also be found in gastric contents.
Because of the presence of phenylethylamine in Psilocybe
semilanceata, urine drug screening tests may show positive
for amphetamine.
2.4 First aid measures and management principles
Gastric emptying and/or charcoal is rarely indicated and
only in very recent ingestion while the patient is still
asymptomatic.
The patient should be put in a quiet room with dim lights and
treated in a reassuring manner.
Benzodiazepines are recommended as a sedative e.g. diazepam
in a dose of 5 to 10 (-20) mg intravenous in adults and 0.1
to 0.2 mg/kg intravenous in children.
In case of seizures diazepam is the drug of choice.
2.5 Poisonous parts
All parts of the mushroom are toxic.
2.6 Main toxins
Psilocybin, psilocin, baeocystin, norbaeocystin.
Phenylethylamine.
3. CHARACTERISTICS
3.1 Description of the fungus
3.1.1 Special identification features
3.1.2 Habitat
3.1.3 Distribution
3.2 Poisonous parts of the fungus
3.3 The toxin(s)
3.3.1 Name(s)
The main toxins are psilocybin, psilocin,
baeocystin and norbaeocystin.
3.3.2 Description, chemical structure, stability
3.3.3 Other physico-chemical characteristics
3.4 Other chemical contents of the fungus
4. USES/CIRCUMSTANCES OF POISONING
4.1 Uses
4.1.1 Uses
4.1.2 Description
Used as a recreational drug.
The mushrooms are usually ingested raw in fresh or
dried condition. Sometimes they are boiled in water
whereupon the water as well as the remaining mushrooms
are ingested. They can also be stewed or mixed in a
salad, soup or omelette. Occasionally, ethanol extract
is used. Intravenous injection of mushroom juice has
occurred.
These mushrooms have a bitter taste.
4.2 High risk circumstances
4.3 High risk geographical areas
Not applicable. Mushrooms containing psilocybe are
often readily available on the illegal market or via the
Internet. They are also easy to cultivate at home and
special "kits" for this purpose can be purchased.
5. ROUTES OF EXPOSURE
5.1 Oral
The most common route of exposure.
5.2 Inhalation
No data available.
5.3 Dermal
No data available.
5.4 Eye
No data available.
5.5 Parenteral
A few cases of intravenous injection of mushroom juice
are reported (Sivyer & Dorrington, 1984; Curry & Rose,
1985).
5.6 Others
No data available.
6. KINETICS
6.1 Absorption by route of exposure
In a controlled clinical study the pharmacokinetic
properties of psilocybin were studied. The metabolites
psilocin and 4- hydroxyindole-3-acetic acid (4HIAA) were
measured in plasma.
The average peak concentration of psilocin after oral
administration of 10 to 20mg psilocybin was 8.2 ( 2.8 ng/ml
plasma and were measured after 105 ± 37 min.
4HIAA reached its maximum concentration of 150 ± 61 ng/ml
plasma after 113 ± 41 min.
After intravenous injection of 1mg psilocybin peak plasma
concentration of psilocin was found 1.9 ± 1.0 min after
injection.
The bioavailability of psilocybin after oral administration
of psilocybin were 52.7 ± 20% (Hasler et al., 1997).
6.2 Distribution by route of exposure
No human data.
6.3 Biological halflife by route of exposure
No data available.
6.4 Metabolism
The maximum plasma levels of psilocin appearing within
a very short period after systemic administration indicates a
rapid dephosphorylation of psilocybin within the human body
(Hasler et al., 1997).
Psilocin is further metabolized by monoamine oxidase (MAO)
leading to formation of 4- hydroxyindole-3-acetic acid (Beck
et al., 1998).
6.5 Elimination and excretion
The metabolite 4- hydroxyindole-3-acetic acid (4HIAA) is
excreted in urine.
7. TOXINOLOGY
7.1 Mode of action
Psilocybin, psilocin, baeocystin and norbaeocystin are
all indoles which are derivates from tryptamin. They are
thought to act by altering the concentration of indoles,
including serotonin, in the central nervous system and thus
interfering with the transmission and processing of external
stimuli (Young et al., 1982).
Phenylethylamine (PEA) recently found in Psilocybe
semilanceata has been associated with psychosis and
implicated in the etiology of mental disease (Wolf and
Mosnaim, 1983, O'Reilly and Davis 1994). PEA has been
reported to exert amphetamine-like activity and to have
peripheral sympathomimetic effects (Mantegazza & Riva, 1963;
Sabelli & Giardina, 1972; Ortman & Steen, 1973).
7.2 Toxicity
7.2.1 Human data
7.2.1.1 Adults
10 to 40g of raw or 1 to 4g of dried
mushrooms are considered as an average dose
in recreational use. However, the
concentration of indoles as well as
phenylethylamine in Psilocybe semilenceata
may vary considerably, and there is no
correlation between number of mushrooms
ingested and symptoms ( Peden et al., 1982;
Francis and Murray, 1983; Beck et al.,
1998).
7.2.1.2 Children
No data available.
7.2.2 Relevant Animal data
Not relevant.
7.2.3 Relevant in vitro data
Not relevant.
7.3 Carcinogenicity
No data available.
7.4 Teratogenicity
No data available.
7.5 Mutagenicity
No data available.
7.6 Interactions
No data available.
8. TOXICOLOGICAL ANALYSES AND BIOMEDICAL INVESTIGATIONS
8.1 Material sampling plan
8.1.1 Sampling and specimen collection
8.1.1.1 Toxicological analyses
To be completed.
8.1.1.2 Biomedical analyses
Not indicated.
8.1.1.3 Arterial blood gas analysis
Not indicated.
8.1.1.4 Haematological analyses
Not indicated.
8.1.1.5 Other (unspecified) analyses
Not indicated.
8.1.2 Storage of laboratory samples and specimens
8.1.2.1 Toxicological analyses
To be completed.
8.1.2.2 Biomedical analyses
Not indicated.
8.1.2.3 Arterial blood gas analysis
Not indicated.
8.1.2.4 Haematological analyses
Not indicated.
8.1.2.5 Other (unspecified) analyses
Not indicated.
8.1.3 Transport of laboratory samples and specimens
8.1.3.1 Toxicological analyses
To be completed.
8.1.3.2 Biomedical analyses
Not indicated.
8.1.3.3 Arterial blood gas analysis
Not indicated.
8.1.3.4 Haematological analyses
Not indicated.
8.1.3.5 Other (unspecified) analyses
Not indicated.
8.2 Toxicological Analyses and Their Interpretation
8.2.1 Tests on toxic ingredient(s) of material
8.2.1.1 Simple Qualitative Test(s)
8.2.1.2 Advanced Qualitative Confirmation Test(s)
8.2.1.3 Simple Quantitative Method(s)
8.2.1.4 Advanced Quantitative Method(s)
8.2.2 Tests for biological specimens
8.2.2.1 Simple Qualitative Test(s)
8.2.2.2 Advanced Qualitative Confirmation Test(s)
8.2.2.3 Simple Quantitative Method(s)
8.2.2.4 Advanced Quantitative Method(s)
8.2.2.5 Other Dedicated Method(s)
8.2.3 Interpretation of toxicological analyses
Analyses of psilocybe mushroom toxins in
biological specimens may confirm the diagnosis.
However, toxicological analyses are of no importance
for the treatment of the poisoned patient. It could
be useful in the differential diagnosis between
drug-induced psychosis and psychosis from other
etiology.
8.3 Biomedical investigations and their interpretation
8.3.1 Biochemical analysis
8.3.1.1 Blood, plasma or serum
There is seldom any need for
biomedical investigations in psilocybe
mushroom poisoning.
8.3.1.2 Urine
8.3.1.3 Other fluids
8.3.2 Arterial blood gas analyses
8.3.3 Haematological analyse
8.3.4 Interpretation of biomedical investigations
8.4 Other biomedical (diagnostic) investigations and their
interpretation
8.5 Overall interpretation of all toxicological analyses and
toxicological investigations
8.6 References
9. CLINICAL EFFECTS
9.1 Acute poisoning
9.1.1 Ingestion
Symptoms appear within 20 to 30 ( to 60)
minutes after ingestion. The intoxication culminates
after about 1.5 hours and subsides within 6 to 12
hours. Central nervous symptoms dominate with
hallucinations and disturbed sensory perception.
Euphoria or anxiety, agitation and panic attacks
leading to violent uncontrolled behaviour pose a risk
for physical trauma, also for other persons. Somatic
signs of intoxication include mydriasis, tachycardia,
hypertension, hyperreflexia, nausea and vomiting. One
case of seizures, cardiopulmonary arrest and
myocardial infarction is reported. Delayed reactions
(flash-backs) may occur.
9.1.2 Inhalation
No data available.
9.1.3 Skin exposure
No data available.
9.1.4 Eye contact
No data available.
9.1.5 Parenteral exposure
Intravenous injection of mushroom juice
resulted in chills, rigors, dyspnea, headache,
arthralgia, myalgia, fever, nausea, vomiting,
diarrhoea and laboratory signs of hepatic and renal
abnormalities.
9.1.6 Other
No data available.
9.2 Chronic poisoning
9.2.1 Ingestion
No data available.
9.2.2 Inhalation
No data available.
9.2.3 Skin exposure
No data available.
9.2.4 Eye contact
No data available.
9.2.5 Parenteral exposure
No data available.
9.2.6 Other
No data available.
9.3 Course, prognosis, cause of death
The majority of poisonings by psilocybe mushrooms has a
short and uncomplicated course. Trauma due to violent and
uncontrolled behaviour poses the greatest threat to the
patient.
9.4 Systematic description of clinical effects
9.4.1 Cardiovascular
Tachycardia and/or moderate hypertension are
rather frequent cardiovascular symptoms.
ST-elevations on the ECG have been observed in a
young, earlier healthy patient. One case of
myocardial infarction in connection with seizures and
cardiopulmonary arrest is reported.
9.4.2 Respiratory
Dyspnea and impaired oxygenation has occurred
after intravenous exposure.
9.4.3 Neurological
9.4.3.1 Central nervous system (CNS)
Visual, auditory and tactile
hallucinations together with disturbed
sensory perception like visual distorsions,
e.g. heightened awareness of colours and a
sensation of objects changing shape are the
most common symptoms of neurotoxicity.
Body image distorsions, depersonalization,
derealization and altered time and space
sense are also frequent phenomenona.
Seizures may rarely occur.
9.4.3.2 Peripheral nervous system
Numbness or tingling in the skin are
frequent symptoms.
One case of unilateral paraesthesiae
affecting face and arm lasting more than 24
hours is described.
9.4.3.3 Autonomic nervous system
Mydriasis is almost regular.
Flushing of the face is sometimes
observed.
9.4.3.4 Skeletal and smooth muscle
Hyperreflexia is a common finding.
9.4.4 Gastrointestinal
Nausea and vomiting may occur. Diarrhoea has
been observed after intravenous exposure.
9.4.5 Hepatic
Laboratory signs of hepatic abnormalities have
been noted after intravenous exposure.
9.4.6 Urinary
9.4.6.1 Renal
Laboratory signs of renal
abnormalities have been noted after
intravenous exposure.
9.4.6.2 Other
Involuntary passage of urine has
been observed
(Peden et al., 1982; Westberg and
Karlson-Stiber, 1999).
9.4.7 Endocrine and reproductive systems
No data available.
9.4.8 Dermatological
No data available
9.4.9 Eye, ear, nose, throat: local effects
No data available.
9.4.10 Haematological
No data available.
9.4.11 Immunological
No data available.
9.4.12 Metabolic
9.4.12.1 Acid-base disturbances
No data available.
9.4.12.2 Fluid and electrolyte disturbances
No data available.
9.4.12.3 Others
No data available.
9.4.13 Allergic reactions
No data available.
9.4.14 Other clinical effects
9.4.15 Special risks
9.5 Other
9.6 Summary
Most poisonings by psilocybin containing mushrooms have
a short and uncomplicated course. Hallucinations, disturbed
sensory perception, euphoria or anxiety, agitation and panic
attacks are common in patients seeking medical attention.
Mydriasis, tachycardia, hypertension, hyperreflexia, nausea
and vomiting are symptoms often observed. Delayed reactions
(flash-backs) may occur.
10. MANAGEMENT
10.1 General principles
The patient should be treated in a reassuring manner
and placed in a quiet room with dim lights. Sedatives are
given as required.
10.2 Life supportive procedures and symptomatic/specific treatment
Diazepam is recommended as a sedative and given as
required. Dose: 5 to 10 (to 20)mg intravenous in adults and
0.1 to 0.2mg/kg intravenous in children.
In case if seizures diazepam is the drug of choice and given
as required.
10.3 Decontamination
Gastric emptying and/or charcoal is rarely indicated
and only in very recent ingestion while the patient is still
asymptomatic.
10.4 Enhanced elimination
No data available. Not indicated because of the short
course of psilocybe mushroom poisoning.
10.5 Antidote/antitoxin treatment
10.5.1 Adults
Not available.
10.5.2 Children
Not available.
10.6 Management discussion
Precautionary measures to protect the patient and other
people from physical trauma due to uncontrolled behaviour
during the hallucinatory phase should be taken. If a mix-up
with other mushrooms is suspected repeated laboratory tests
of hepatic and renal function may be appropriate.
11. ILLUSTRATIVE CASES
11.1 Case reports from literature
a) Peden et al. 1982 reported data from 44
patients presenting to hospital within a 5 week
period. The patients presented to hospital usually
because of dysphoric effects. Mydriasis was observed
in 40 patients. Other sympathomimetic features such
as tachycardia, hypertension or hyperreflexia were
seen in less than half of the patients. Nausea and
vomiting prior to appearing at hospital had occurred
in 12 cases. Four patients had been incontinent of
urine.
The following are cases reported from the Swedish Poisons
Centre:
a) A 21-year-old man was escorted to the hospital by two
police officers. He was unable to give a complete
account of recent events but did admit ingestion of 3
grams dried Psilocybe cubensis which he had purchased
over the Internet. On admission, he was agitated and
violent. After ripping out his intravenous catheter),
he kicked and shoved one doctor, threw a
fire-extinguisher at another and attacked his girl
friend - among other things trying to strangle her. A
few hours later he was filled with remorse and
indicated his actions were precipitated by fear. He
recalled vivid hallucinations of his intestines
spilling out of his body and the delusion of being
castrated by a stranger. This patient recovered
quickly with bed rest and was discharged the following
morning.
b) A 24-year-old man presented to the hospital after
drinking heavily and ingesting an unknown quantity of
magic mushrooms at a party. On admission, the patient
was agitated and aggressive. On examination he had
mydriasis, tachycardia and non-specific
electrocardiogram-changes. He later admitted that his
aggressive behaviour was prompted by fear. About one
hour after eating the mushrooms, he recalled having
frightening hallucinations such as electric cables
coming out of the walls and winding around him. He
was discharged after one night of bed rest.
c) After drinking several beers with friends after work,
a 33-year-old man ingested 6 grams dried Psilocybe
cubensis and a short while later developed severe
anxiety and hallucinations. Thinking he was going to
die, he panicked and called an ambulance. On arrival
at the hospital he was restless, had hesitating
speech, amnesia, mydriasis and tachycardia. Four
hours later, he still had chills, a dry mouth and
musculoskeletal cramps and pain. He was admitted for
observation and bed rest and discharged the following
morning after complete recovery.
12. Additional information
12.1 Specific preventive measures
12.2 Other
13. REFERENCES
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Presence of phenylethylamine in hallucinogenic psilocybe mushroom:
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Benjamin C (1979) Persistent psychiatric symptoms after eating
psilocybin mushrooms. BMJ19 May:1319-20
Borowiak KS, Ciechanowski K & Waloszczyk P (1998) Psilocybin
mushroom ( Psilocybe semilanceata) intoxication with myocardial
infarction. J Toxicol Clin Toxicol 36:47-49
Curry SC et al. (1985) Intravenous mushroom poisoning Ann Emerg
Med 14(9):900-902
Dewhurst K (1980) Psilocybin intoxication. Br J Psychiat 137:303-4
Francis J & Murray VSG (1983) Review of enquiries made to the
NIPIS concerning psilocybe mushroom ingestion, 1978-1981. Hum
Toxicol 2: 349-52
Franz M et al. (1996) Magic mushrooms: hope for a "cheap high"
resulting in end-stage renal failure. Nephrol Dial Transplant
11:2324-47
Harries A & Evans V (1981) Sequelae of a 'magic mushroom banquet'
Postgrad Med J 57:571-2
Hasler F, Bourquin D, Brenneisen R, Bär T & Vollenweider FX (1997)
Determination of psilocin and 4-hydroxyindole-3-acetic acid in
plasma by HPLC-ECD and pharmacokinetic profiles of oral and
intravenous psilocybin in man. Pharm Acta Helv 72:175-84
Holmgaard Kristensen L & Harding Serensen B (1988) Vedvarende
symptomer efter indtagelse af hallucinogene svampe Ugeskr Laeger
150:1224-5
Kunz MW, Rauber-Lüthy Ch, Meier PJ, Kupferschmidt H. (2000) Acute
poisoning with hallucinogenic psilocybe mushrooms in Switzerland.
EAPCCT XX International Congress 2-5 May, 2000, Amsterdam,
Netherlands. (Abstract nr 99).
Mantegazza P & Riva M (1963) Amphetamine-like activity of
ß-phenylethylamine after a monoamine oxidase inhibitor in vivo J
Pharmacol 15:472-78
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14. AUTHOR(S), REVIEWER(S) DATA (INCLUDING EACH UPDATING), COMPLETE
ADDRESSES
Dr C. Karlson-Stiber
Swedish Poison Information Centre
S-171 76 Stockholm
Sweden
Tel: +46 8 6100533
Fax: +46 8 327584
E-mail: christine.karlson-stiber@apoteket.se
Date: 18 October 2000
Reviewed by:
* Dr Heinz Faulstich, Dr Luc de Haro, Dr Jonas Höjer,
Dr Christine Karlson-Stiber, Dr Hans Persson and Dr Thomas
Zilker (Meeting on Mushroom Poisoning, 19-21 October 2000,
Stockholm, Sweden).
* Dr B. Groszek and Dr Hans Persson (INTOX-12,
6-11 November 2000, Erfurt, Germany)