Additional Information Necessary

I would like to add a few points to the clear, informative, and detailed article on mushroom poisoning (1). Clitocybe rivulosa is highly toxic due to its muscarine content, whereas the frosty funnel Clitocybe phyllophila does not contain muscarine and is not poisonous (2). In Table 1 (1), Clitocybe rivulosa, the fool‘s funnel, is correctly named as an example of a muscarinic white clitocybe. Because of the considerable risk of confusion, mushroom advisors and experts do not approve white clitocybes for consumption.

The problem of sedative measures in panther cap/fly agaric syndrome is pointed out in Table 3a (1). In mild cases, monitoring and letting the patient “sleep it off” are often sufficient.

For the most severe, life-threatening poisoning with clear anticholinergic symptoms due to panther cap, fly agaric, or royal fly agaric mushrooms, the centrally and peripherally acting active ingredient physostigmine has been available to experienced intensive care physicians since 2013, and has been approved for this indication since 2006. Physicians must carefully weigh the benefits and risks of this last resort therapy for each individual case (3).

Further, I would like to give a tip on rapid identification of mushrooms containing amanitin and orellanin: a mushroom expert trained in clinical diagnostics can use very simple, qualitative, and reliable chemical tests to clarify whether pieces of fruit, cleaning residues, cooking leftovers, or vomit contain amanitin or orellanin. The Wieland newspaper test (in the Anglo-American language area: Meixner test), which only requires concentrated hydrochloric acid, is used to detect amanitin. For the orellanine detection assay according to Pöder and Moser, iron (III) chloride is necessary. These test methods have been tried and tested for many years in mushroom expert consultation, take only a few minutes, and usually allow rapid detection or exclusion of these toxins.