Poisonous mushrooms are a group of higher mushrooms that are toxic to humans or animals and often grow in environments with many trees, decaying leaves, humidity and high temperatures. Mushroom toxicity is complex, one kind of mushroom often contains a variety of toxins, and a toxin often exists in a variety of mushrooms. The clinical manifestations of mushroom poisoning are complex and varied because of a variety of factors related to cooking methods and dietary habits. Mushroom poisoning can be caused by accidental ingestion and is often very serious and life-threatening. The death rate of mushroom poisoning is always high, up to 50%, and is often characterized by the gathering of families. There are many misconceptions about poisonous mushrooms The mushrooms generally have raised lumps of sarcoma on the top, ring-like objects on the stalk (foot bracts), and ring-like torus on the roots, with bitter, spicy, sour, and numb, etc. The colors are bright and easy to discolor after harvesting, most are soft, and the pulp is juicy and cloudy like milk. But experts pointed out that there are many kinds of wild mushrooms, identification requires professional knowledge and with the help of professional equipment, ordinary people rely only on experience is difficult to accurately identify mushroom species, to distinguish between poisonous mushrooms and non-toxic mushrooms. Myth 1: The brightly colored mushrooms are poisonous, and the common color mushrooms are not poisonous. The color and shape cannot simply distinguish whether the mushrooms are poisonous or not; for example, the Chanterelles and the big red mushrooms are brightly colored and delicious to eat; while the gray patterned goose paste and the deadly goose paste are highly poisonous mushrooms, and the color is gray or white. Myth 2: Mushrooms that grow in damp places or on livestock dung are poisonous, while those that grow under pine trees and other clean places are not. Most mushrooms grow in dark and damp places, but not all are edible; some poisonous mushrooms do like to grow in dung, such as helmet spores and some poisonous species in the genus Pleurotus; in addition, some poisonous species of goose paste, mushrooms, and red mushrooms also grow in pine forests. Myth 3: Mushrooms are cooked with silverware, ginger, rice, raw onion, the liquid becomes black and toxic, no color change is not toxic Mushroom toxins do not react chemically with silverware, the most toxic of the poisonous mushrooms gooseberry toxins, and no color change occurs during the steaming process. Myth 4: Mushrooms with secretions or wounded and discolored are poisonous Some juicy mushrooms change color after injury, they are not only non-toxic, but also delicious edible mushrooms. Myth 5: Mushrooms with maggots and worms are not poisonous Many highly toxic gooseberries also produce maggots and worms after maturation. Diagnosis of poisonous mushroom poisoning Patients have a history of eating wild mushrooms by mistake, the onset of the disease in one family or several families in the same area at the same time, the severity of the disease is positively correlated with the amount of poisonous mushrooms eaten, etc., and then combined with clinical manifestations, you can make a diagnosis. However, if the patient has a history of mushroom consumption and is in the pseudo-healing period or incubation period, we should be especially vigilant and pay attention to monitoring, and should not take it lightly. Diagnostic considerations: ① Patients with poisoning have consumed a common poisoned food in a similar period of time; those who have not consumed it do not develop the disease; ② The incubation period is short, the onset is rapid, and the duration of the disease is short; ③ The clinical manifestations of all poisoned patients are basically similar; ④ The onset of human contact is not human; ⑤ The determination of food poisoning should have laboratory diagnostic information as much as possible; if necessary, the remaining poisonous mushrooms can be fed to animals for confirmation. Clinical attention should be paid to the differential diagnosis between the neuropsychiatric type and schizophrenia, the gastroenteritis type and bacterial food poisoning and acute gastroenteritis, and the hemolytic type and other diseases causing hemolytic anemia. Routine first aid treatment at a primary hospital After finding poisoning from mushrooms, the first step should be to take self-help. Previously healthy adults can induce vomiting within 4h after eating. Patients should go to a regular hospital as soon as possible, and it is best to bring a sample of the remaining mushrooms with you when you visit the hospital for further clarification of the diagnosis and guidance on treatment. Remove unabsorbed toxins to prevent further absorption of toxins. 1. Emetic: If the patient is clear and cooperative, drink 300-500 mL of warm water and then stimulate the posterior pharyngeal wall or tongue root with fingers or tongue depressor or chopsticks to induce vomiting; this can be done repeatedly until the stomach contents are completely vomited out. 2, gastric lavage choose a thicker gastric tube, the head coated with paraffin oil lubrication; from the oral cavity down into about 50 cm, aspirate 100 ~ 200 mL of gastric juice to confirm the gastric tube is indeed in the stomach, and can be toxic analysis; if you can not determine the tube in the stomach, you can inject appropriate air into the stomach, while in the stomach area to hear the “gurgling” sound, that is, to confirm Gastric tube in the stomach; gastric lavage with the patient in a left-sided position, head low and feet high and turned to the side, so as not to lavage the gastric fluid into the trachea by mistake. 3. Use water or 0.5% activated carbon suspension for gastric lavage, inject 200-250 mL each time, and try to make it discharged after each irrigation; repeatedly lavage until the recovered liquid is clarified. Gastric lavage solution at least 2 ~ 5 L; when removing the tube, the tail of the gastric tube should be clamped first to avoid regurgitation of fluid in the tube into the trachea during the removal of the gastric tube, resulting in aspiration pneumonia. 4, induced diarrhea: sodium sulfate or magnesium sulfate 15 g dissolved in water, oral or gastric tube injection. 5, enema 24h after the diagnosis, should be given high enema. Can use 1% warm soapy water, continuous multiple enemas. 6.Seriously ill patients can be transferred to a hospital with conditions to carry out blood perfusion and other purification therapy to get rid of the toxins of the poisonous mushroom. Application of antitoxic drugs to counteract toxins There are no specific antitoxic drugs for mushroom poisoning in general. Anticholinergic drugs: antimuscarinic-like effect, choose atropine as the main choice. Dose 0.5-1 mg subcutaneously, once every 2-6 h. If necessary, increase the dose or switch to intravenous injection, but be alert to atropine poisoning. Atropine can also be used to relieve abdominal pain, vomiting, diarrhea and other gastrointestinal symptoms. It is also useful for those with atrioventricular block due to toxic myocarditis. Mercaptan complex agent: poisonous umbrella, white poisonous umbrella and other poisonous mushroom poisoning with atropine treatment is ineffective, can be used disodium dimercaptobutyrate 0.5 ~ 1 g diluted intravenous injection, every 6 h injection, the first dose doubled, after the relief of symptoms to injection 2 times / d, 5-7 d for a course of treatment. Or sodium dimercaptopropionate, 5% solution 5 mL intra-muscular injection or add glucose solution 20 mL intravenous injection, 1~2 times/d, 5~7 d course. When applying anticholinergic drugs, attention should be paid to the drug dose to prevent drug overdose poisoning. When using mercaptans, attention should be paid to the course of treatment, and the duration of treatment should not be easily shortened. Atropine is very effective for neuropsychiatric mushroom poisoning containing muscarinic acid; poisonous umbrella, white poisonous umbrella and other mushroom poisoning is not effective with atropine treatment. Note: ①Patients in coma should not induce vomiting, and try to empty the stomach contents during vomiting; ②Gastric lavage should be performed as early as possible, usually within 6 h of poisoning, but even if the poisoning is >6 h, as some of the poison can still remain in the stomach, gastric lavage should also be performed, especially for poisonous mushrooms such as poisonous umbrella and white poisonous umbrella; ③The patient’s active cooperation should be noted when inserting the gastric tube, and uncooperative patients are prone to gastroesophageal injury when inserting the gastric tube. If necessary, sedative drugs can be used before intubation, and inadvertent entry into the trachea should be prevented; ④Magnesium sulfate catheterization is not suitable for patients with renal insufficiency, respiratory depression or coma; ⑤Enema is suitable for those who have been poisoned for >6 h and for those whose catheterization is ineffective. Differential treatment of different poisoning types. The gastroenteritis type can be treated according to the general treatment methods, especially in the early stage of vomiting, gastric lavage and diarrhea to accelerate the discharge of toxic substances. Neurological and psychotropic type The poisoning of poisonous mushrooms containing poisonous flies and muscarinic-like symptoms can be treated with atropine; the poisoning of poisonous mushrooms containing isoxazolium derivatives can be treated with sedatives if mental confusion and hallucinations occur; the poisoning of poisonous botrytis causes psychotic symptoms such as hallucinations in small human countries and can be treated as mental abnormalities. Hemolytic type The drugs for treating this type of poisoning include prednisone, cortisone, sodium bicarbonate, etc. Severe anemia can be treated with adrenal corticosteroids or blood transfusion. The liver damage type can take comprehensive treatment measures and timely treatment mainly for liver protection. In addition to the general treatment of mushroom poisoning described above, mercaptans, adrenocorticosteroids, N-acetylcysteine, and large amounts of vitamin B and C vitamins can be used. Liver protection measures should also be carried out: giving nutritious and easily digestible substances, as well as GIK fluids (glucose, insulin plus potassium chloride); other liver protection drugs. This type of poisoning is very important to carry out rescue treatment mainly for detoxification and liver protection during the initial gastroenteritis period, but because it has an incubation period and a pseudo-healing period, it is easy to miss a good opportunity for rescue treatment. Because this type of poisoning can simultaneously damage the kidneys and other organs of patients, it can cause imbalance of fluid and water-soluble substance metabolism, so special attention should be paid to the use of diuretics and electrolyte replenishment while rehydrating. For photoallergic dermatitis, drugs such as Anchormin, paracetamol, diphenhydramine, hydrocortisone and vitamin C can be used. If the eyes are congested, pay attention to eye protection and use hydrocortisone ointment. Warm tip: There is no special medicine for mushroom poisoning, avoiding it is the key. If you do not have the conditions, you should not blindly treat the poisoned mushroom, but transfer it to a hospital with rescue conditions for further treatment as soon as possible while maintaining stable vital signs. Before transferring to a higher level hospital, they should assess the risks and explain their condition, and be accompanied by medical and nursing staff, and prepare the drugs and resuscitation equipment needed during the transfer.