In the second part of this review of
mushroom poisonings, the syndromes with intermediate and long lag-times are discussed. They include the coprinus-, phalloides-,
gyromitrin- and the orellanus syndrome. The coprinus syndrome occurs whenever alcohol is consumed after a meal containing
coprine. The lag-time varies according to the amount and time of alcohol intake. It is very similar to the
disulfiram syndrome which is known from the adverse
therapy of
alcoholism. The lag-time of the phalloides syndrome varies between 7 and 24 hours. It starts with massive
gastroenteritis followed by hepatopathia which can lead to
hepatic coma and
kidney failure. The phalloides syndrome is caused by the amatoxins of the death caps, which inhibit the
RNA Polymerase B in the nucleus of the liver cell. The
gyromitrin syndrome exhibits also a delayed onset. The hepatotoxicity and the nephrotoxicity are less severe than in the phalloides syndrome. The first metabolite of
gyromitrin monomethylhydrazin is responsible for CNS-symptoms such as
delirium and convulsions. In contrast to the phalloides syndrome
vomiting can be the only leading symptom in
gyromitrin poisoning. The orellanus syndrome has the most delayed onset of all
mushroom poisonings with 1-3 weeks. It should be thought of in all cases of
kidney insufficiency of unknown origin. The orellanines damage the kidney and induce all degrees of
kidney insufficiency according to the amount of ingested
poison. Terminal
kidney failure which requires
hemodialysis treatment can occur in severe cases.