Many of the patients who ingested a “poisonous’ mushroom will not require laboratory testing. However, if any laboratory tests are done, they should be driven by the patient’s clinical condition and the most likely responsible toxin. The latter being based on the identification of the mushroom.
In all mushroom poisonings where there is severe vomiting and diarrhea, a basic metabolic profile is appropriate for the evaluation of fluid and electrolyte disturbances. Liver function studies, both as a baseline and monitoring, are indicated for hepatotoxic toxins such as Amanitin and Gyromitrin. In addition to alaninetransaminase (ALT), aspartatetransaminase (AST), alkaline phosphatase (ALP), gamma-glutamyltranspeptidase (GGT), total protein, albumin, and bilirubin, a prothrombin time (PT) and activated partial thromboplastin time (aPTT) is advised.
Kidney function studies are in order when a nephrotoxic mushroom is ingested and should include blood urea nitrogen (BUN), creatinine, urinalysis, and an estimated glomerular filtration rate (eGFR). Examples of nephrotoxins include Gyromitrin, Orellanine, and an unknown toxin found in Amanita smithiana, A. proximia, and A. pseudoporphyria.
