Substance
Mushrooms containing cyclopeptides

[Other Names]
Amanita phalloides, (death cap)
Amanita tennifolia,
Amanita virosa, (destroying angels)
Galerina autumnalis,
Galerina marginata,
Galerina venenata,
Lepiota helveola,
Lepiota josserandii

Pathology
Cytotoxicity of cyclopeptides (phallotoxins, amatoxins, virotoxins), cellular insult causing hepatic, renal, GI, and CNS damage.

Symptoms
Phase 1 (6–12 hr): Nausea, abdominal pain, vomiting, watery diarrhea, thirst.
Phase 2 (12–24 hr): Symptomatic improvement, elevated hepatic enzymes.
Phase 3 (1–6 days): Restlessness, delirium, hallucinations, hematuria, gastroenteritis, pancreatitis, hypoglycemia, shock, acute renal failure, jaundice, hepatic coma, death.

Emergency Measures
Activated charcoal; fluid and electrolyte resuscitation; hepatic transplantation in fulminant hepatic failure.

Comments
Cyclopeptide-containing mushrooms are responsible for most mushroom fatalities in North America. Toxic cyclopeptides are heat stable, insoluble in water, and not affected by drying.