Fast Five Quiz: Psilocybin and Other Hallucinogenic Drugs

Richard H. Sinert, DO

Disclosures

September 07, 2021

A complete blood cell count should be obtained because some mushroom toxins (eg, gyromitrin) can cause hemolytic anemia.

Baseline liver function studies are indicated because possible ingestion of other toxic mushrooms (eg, those containing cyclopeptides) can cause hepatotoxicity. Baseline renal function studies are indicated because some mushrooms are nephrotoxic. Evaluation for rhabdomyolysis should be considered if signs and symptoms warrant it because some mushrooms (eg, Tricholoma equestre) may cause muscle toxicity.

Laboratory studies can be helpful in identifying complications of hallucinogenic mushroom abuse, which may include hepatotoxicity with repeated use, acute renal failure, and rhabdomyolysis. Serum and urine tests for such toxins as muscarine, muscimol, and psilocybin are available but are rarely helpful or necessary in clinical practice. They are more applicable to forensic investigations.

Chromatographic techniques (eg, thin-layer chromatography, gas-liquid chromatography, and high-performance liquid chromatography) are available to detect ibotenic acid, muscimol, and psilocybin, as well as other mushroom toxins (eg, amanitins, orellanine, muscarine, and gyromitrins). However, these techniques are typically unavailable to general practitioners, being largely restricted to laboratories conducting research on these compounds.

Read more on the workup of patients with suspected psilocybin-containing mushroom ingestion.

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