野生蘑菇和有毒植物攝取急救和毒物分類¶

食用來自森林或後院草坪的不明野生蘑菇，將有毒的野生鐵杉或毛地黃誤認為是可食用的花園藥草，或發現幼兒咀嚼了家用觀賞植物，都會造成緊急的毒理學緊急情況。雖然許多後院蘑菇和室內植物只會引起短暫的口腔刺痛或輕微的胃部不適，但致命的物種：最明顯的是含鵝膏毒素的鵝膏菌蘑菇（“死亡帽”和“毀滅天使”）、水毒芹、毒毒芹、夾竹癲癇、紅豆杉和附子（附心神經神經衰竭：可導致暴發性心臟衰竭的性發作。

本指南提供了符合世界衛生組織 (WHO)、美國毒物中心（美國）、疾病管制與預防中心 (CDC)、北美真菌學協會 (NAMA) 和英國國家毒物資訊服務 (NPIS) 臨床方案的分步緊急程序。了解 6 小時蘑菇症狀潛伏期規則，將完整的植物或真菌標本保存在紙袋中，並立即聯繫毒物控製或緊急服務部門，可以挽救生命。

現在就這樣做¶

如果您或附近的人（尤其是兒童）吞嚥、咀嚼或烹調野生蘑菇或可能有毒的植物、莓果、球莖或根：

1. 清潔口腔並用水沖洗（不要吞嚥）：立即用乾淨的手指或濕布輕輕擦去患者口腔中殘留的蘑菇碎塊、葉子、漿果或種子。讓他們用水漱口並將其吐出。如果他們咀嚼了會立即引起灼熱感和流口水的植物（例如啞甘蔗/萬年青或喜林芋），請讓他們喝涼水或牛奶或吮吸冰棍來舒緩口腔粘膜。
2. 立即致電緊急服務或中毒控制中心：
3. 立即撥打您當地的緊急電話號碼（美國和加拿大撥打 911，歐盟撥打 112，英國撥打 999） 緊急號碼 目錄）如果該人有呼吸困難、喉嚨腫脹、意識模糊、幻覺、肌肉抽搐、 癲癇發作、心跳緩慢或不規律、昏厥，或在食用野生蘑菇後 6 小時以上開始嘔吐/腹瀉。
4. 立即致電毒物控制中心（在美國，請致電 1-800-222-1222；在英國，請致電 NHS 111）如果該人目前沒有症狀或僅有輕微的口腔不適，即使幼兒只舔或咬了院子裡的一個蘑菇帽。
5. 切勿在家催吐：不要將手指放入喉嚨，不要餵食鹽水或芥末水，也不要使用吐根糖漿。誘導嘔吐並不能可靠地去除蘑菇毒素，如果神經毒素引發突然癲癇發作或嗜睡，則可能導致致命的吸入性肺炎。
6. 將完整、完整的蘑菇（從底部挖出）收集在紙袋中：不要將剩餘的蘑菇或植物扔進垃圾桶，並且不要將新鮮蘑菇密封在密封塑膠袋中（其中殘留的水分會在數小時內將它們變成無法識別的粘液）。用小刀或抹子小心地挖出整個蘑菇，包括莖基部的地下杯/球莖（蘑菇），用蠟紙或乾紙巾包裹，然後將其放入棕色紙袋中。
7. 從多個角度拍攝高解析度智慧型手機照片：去醫院之前，拍攝蘑菇或植物的清晰、光線充足的特寫照片：(a) 其生長的棲息地（土壤、草坪或枯木），(b) 菌蓋頂部，© 菌蓋下側，顯示莖上的菌褶、毛孔或環/裙邊，以及 (d) 完整的地下底座。毒物中心可以將這些照片直接透過簡訊或電子郵件發送給待命的專業真菌學家或植物學家，以進行快速物種鑑定。
8. 檢查分享這頓飯的其他人：如果野生蘑菇或採摘的蔬菜被煮成家庭湯、麵食或炒菜，每個吃過這道菜的人都必須在醫院接受評估，即使有些家庭成員現在感覺完全正常。

緊急分診與真菌學決策流程圖¶

flowchart TD
    Start["攝取野生菇類或有毒植物"] --> Airway{"是否有癲癇發作、精神錯亂、脈搏緩慢/不規則或呼吸困難？"}

    Airway -->|Yes: Immediate Life Threat| Call911["立即撥打 911 / 112 / 999<br/>擦乾淨嘴；不經口給予任何東西<br/>側臥（恢復位置）；準備心肺復甦"]

    Airway -->|No: Alert with stable core clinical signs| Type{"是否攝取了野生蘑菇或綠色植物/漿果？"}

    Call911 --> Type

    Type -->|Wild Mushroom Ingested| Latency{"吃蘑菇後多久開始嘔吐/腹瀉？"}

    Latency -->|Asymptomatic right now (Just eaten)| PoisonCall["擦嘴；將整個蘑菇（帶地下底座）收集在紙袋中<br/>拍攝蘑菇蓋、菌褶、莖和底座的照片<br/>致電毒物控制中心（美國為 1-800-222-1222）或前往急診室獲取活性炭"]

    Latency -->|Early Onset: Symptoms started < 6 hours after eating<br/>(Usually 30 min to 3 hours)| EarlyMush["Likely GI Irritant, Muscarine, or Neuro-Hallucinogenic Mushroom<br/>Go to Emergency Department for IV fluids and symptom care<br/>WARNING: Ask if multiple mushroom species were mixed in the same meal"]

    Latency -->|Delayed Onset: Symptoms started > 6 hours after eating<br/>(6 to 24 hours, or days later for Cortinarius)| LateMush["CRITICAL EMERGENCY: Suspected Amatoxin / Gyromitrin / Orellanine<br/>Go to Hospital Emergency Department IMMEDIATELY<br/>Requires aggressive IV hydration, Multidose Activated Charcoal,<br/>IV N-Acetylcysteine / Silibinin, and Liver Transplant Center alert"]

    Type -->|Plant, Leaf, Berry, Bulb, or Root Ingested| PlantType{"What symptoms or plant species are involved?"}

    PlantType -->|Immediate mouth burning & drooling after chewing houseplant<br/>(Dieffenbachia, Philodendron, Peace Lily, Pothos)| Oxalate["Insoluble Calcium Oxalate Crystal Irritation<br/>Wipe mouth; give cool milk, water, or popsicle<br/>Call Poison Control; monitor for rare airway swelling"]

    PlantType -->|Foxglove, Oleander, Lily of the Valley, Yew, Monkshood,<br/>Hemlock, Jimsonweed, Castor Bean, or Deadly Nightshade| LethalPlant["HIGH-RISK SYSTEMIC PLANT TOXIN<br/>Go to Hospital Emergency Department Immediately<br/>Requires continuous ECG monitoring, Activated Charcoal,<br/>and specific antidotes (Digoxin Fab, Physostigmine, Benzodiazepines)"]

Part 1: Wild Mushroom Poisoning (Mycetismus) and the 8 Clinical Syndromes¶

Of the more than 10,000 known species of macrofungi worldwide, fewer than 100 are clinically poisonous to humans, and roughly a dozen species cause over 95 percent of all fatal mushroom poisonings. However, not a single folk rule or old wives' tale can distinguish a safe mushroom from a deadly one.

Debunking dangerous mushroom folk myths¶

• Myth 1: "Boiling, cooking, drying, or freezing neutralizes mushroom toxins.": FALSE. Amatoxins (the lethal cyclic octapeptides in Death Cap and Destroying Angel mushrooms) are 100 percent heat-stable, freeze-stable, and acid-resistant. Boiling, frying, baking, dehydrating, or digesting in stomach acid does not reduce their lethality at all.
• Myth 2: "Deadly mushrooms taste bitter, acrid, or foul, or tarnish a silver spoon in the cooking pot.": FALSE. Survivors of Amanita phalloides (Death Cap) poisoning universally report that the mushrooms smelled pleasant and tasted delicious, and they never tarnish silver or turn garlic or onions black.
• Myth 3: "If squirrels, deer, rabbits, or slugs eat a mushroom, it is safe for humans.": FALSE. Slugs, insects, and many woodland mammals have different hepatic metabolism and routinely feed on Amanita phalloides without harm.
• Myth 4: "Poisonous mushrooms have bright colors or caps that do not peel easily.": FALSE. The Destroying Angel (Amanita bisporigera / Amanita virosa) is pure, innocent snow-white, while the Death Cap (Amanita phalloides) has a plain greenish-olive or yellowish-tan cap that peels easily and frequently tricks experienced immigrants into thinking it is an edible Asian Paddy Straw mushroom (Volvariella volvacea) or button mushroom (Agaricus).
• Myth 5: "A smartphone mushroom-identification app said it was 98% edible.": FALSE. Poison centers worldwide report a surge in severe poisonings caused by foragers trusting AI photo apps, which routinely fail to see the buried underground volva or spore print colors that separate an edible meadow mushroom from a lethal Amanita.

按症狀發作劃分的蘑菇中毒症候群主表¶

臨床醫師將蘑菇中毒分為遲髮型綜合症（> 6 hours，高死亡率和器官衰竭）和早發綜合症（< 6 hours，支持性護理很少致命）。

Deep dive into the 4 Stages of Amatoxin (Amanita phalloides) Poisoning¶

Because 90 percent of all mushroom fatalities worldwide are caused by alpha-amanitin in Amanita phalloides (Death Cap), Amanita bisporigera/virosa (Destroying Angel), and Galerina marginata, understanding its four deceptive clinical stages is important:

• Stage 1: The Silent Latency Period (6 to 24 hours after ingestion): For the first 6 to 12 hours after eating the meal, the person feels 100 percent normal. During this silent window, amatoxins are absorbed from the gut, enter liver hepatocytes via OATP1B3 transporters, and irreversibly bind to RNA Polymerase II, halting all messenger RNA transcription and protein synthesis in the liver.
• 第2階段：劇烈胃腸炎階段（攝入後12至36小時）：患者突然出現嚴重腹部絞痛、持續性噴射性嘔吐和大量水樣霍亂樣腹瀉（有時含有血液和粘液），導致嚴重脫水、低血容量休克、低鉀和代謝性酸中毒。
• 第3階段：欺騙性的「假恢復」/蜜月階段（攝取後24至72小時）：第2天或第3天左右，嘔吐和腹瀉消退，並且患者感覺明顯好轉。不知情的患者（以及偶爾不檢查血肝酶的臨床醫生）錯誤地認為他們只是患有 24 小時胃病並回家。 然而，在體內，大量肝細胞正在發生壞死，血清肝轉氨酶（AST 和 ALT）正在攀升至數千。
• 第4階段：爆發性肝腎衰竭（攝取後第3至7天）：黃疸（眼睛和皮膚發黃）、嚴重低血糖（因為死亡的肝臟無法再釋放葡萄糖）、嚴重凝血功能障礙和自發性出血（INR由於不再產生凝血因子而飆升）、肝性腦病、腦水腫、昏迷、急性腎衰竭和早期抗衰老。

為什麼多劑量活性碳可以挽救鵝膏毒素中毒患者的生命¶

即使是毒傘中毒的患者在食用蘑菇後 12 至 36 小時到達醫院，急診醫生仍會透過口腔或鼻胃管每 2 至 4 小時施用多劑量活性碳 (MDAC)。為什麼？因為高達 60% 的吸收的鵝膏毒素被肝臟排泄到膽汁中，倒回小腸上部，並一遍又一遍地重新吸收到血液中（腸肝循環）**。保持活性碳持續流經腸道，將膽汁分泌的鵝膏毒素結合在腸腔中，並經由糞便無害地排出體外。

如何正確收集和拍攝蘑菇或植物以進行識別¶

當您致電毒物控制中心或到達急診室時，醫學毒理學家或諮詢真菌學家需要對標本進行屬和種的鑑定。請遵循以下四個保存規則：

1. 挖出整個蘑菇：永遠不要只折斷蓋子：將致命的鵝膏菌蘑菇與安全的可食用類似蘑菇區分開來的最關鍵的解剖特徵是埋在莖根部地下 2 至 5 厘米（1 至 2 英寸）的囊狀杯或腫脹的球莖（volva）**。使用黃油刀、湯匙或花園抹子在蘑菇下面挖掘，並將整個結構完好無損地提起。
2. 如果成群生長，則收集多個生命階段：如果同時有年輕的“紐扣”蘑菇和成熟的開放蘑菇一起生長，則每個階段挖一到兩個。
3. 請務必使用紙袋或蠟紙：切勿使用塑膠袋：新鮮蘑菇的 90% 是水，採摘後會繼續呼吸。將蘑菇密封在密封塑膠袋或塑膠食品容器內會吸收水分和熱量，導致細菌液化，使樣本在到達實驗室之前變成無法識別的棕色糊狀物。將每個蘑菇放入乾棕色紙午餐袋中，或用蠟紙或乾紙巾鬆散地包裹起來。
4. 保存任何未清洗的輔料、烹飪鍋殘渣或嘔吐物：如果沒有留下完整的蘑菇，請使用乾淨的勺子和防漏標本杯保存從湯鍋中濾出的任何蘑菇碎片、垃圾桶中的輔料，甚至嘔吐物（嘔吐物）：即使在烹飪或消化後，實驗室真菌學家也可以在顯微鏡下識別微觀的孢子。

第 2 部分：致命且常見的家庭/野生植物中毒¶

植物暴露分為兩個不同的組別：常見的家庭觀賞植物（經常被幼兒和寵物咀嚼，立即引起口腔刺激，但很少引起全身中毒）和系統性心臟毒性或神經毒性植物（可在數小時內殺死成人或兒童）。

透過臨床毒理學試驗對有毒植物進行主要比較¶

The deadly "Wild Carrot / Wild Parsnip" foraging trap: Hemlock¶

Every spring and summer, experienced gardeners and foragers are poisoned after mistaking Water Hemlock (Cicuta maculata) or Poison Hemlock (Conium maculatum) for edible wild members of the Apiaceae (carrot/parsley) family, such as Queen Anne's Lace (wild carrot), wild parsnip, wild celery, or anise/fennel.

• How to recognize Poison Hemlock (Conium maculatum): While edible Queen Anne's Lace has a hairy green stem ("the Queen has hairy legs"), Poison Hemlock has a smooth, hairless hollow green stem covered with distinctive purple-red blotches or spots, a musty mouse-urine odor when crushed, and grows up to 2 to 3 meters (6 to 10 feet) tall.
• Why Water Hemlock (Cicuta maculata) is the most acutely lethal plant in North America: Growing along stream banks, marshes, and wet ditches, Water Hemlock has chambered tuberous roots filled with yellowish, oily liquid saturated with cicutoxin. Taking a single bite of a Water Hemlock root mistaken for wild parsnip triggers violent grand mal seizures (status epilepticus) within 15 to 60 minutes, rapidly causing severe rhabdomyolysis, metabolic acidosis, cerebral hypoxia, and death unless immediate ambulance airway management and intravenous benzodiazepines are administered.

常見問題¶

This guide is for informational purposes and does not replace professional medical evaluation or hands-on training. Because severe plant and mushroom poisonings can trigger seizures or cardiac arrest, we recommend taking an accredited first aid and CPR course through the International Federation of Red Cross and Red Crescent Societies (IFRC), your national Red Cross society, St John Ambulance, or a certified local training provider.

來源已檢查¶

• America's Poison Centers & American Association of Poison Control Centers (AAPCC, United States): Clinical Triage Guidelines for Unknown Mushroom Ingestions and Household Plant Exposures.
• North American Mycological Association (NAMA, United States & Canada): Mushroom Poisoning Syndromes: Amatoxin, Gyromitrin, Orellanine, Muscarine, and Gastrointestinal Irritants.
• World Health Organization (WHO): Clinical Management of Acute Poisoning by Plants and Fungi.
• Centers for Disease Control and Prevention (CDC, United States): Morbidity and Mortality Weekly Report (MMWR): Amanita phalloides Mushroom Poisonings and Clinical Treatment Protocols.
• National Poisons Information Service (NPIS, United Kingdom) & NHS: TOXBASE Clinical Management of Fungi (Amatoxins) and Cardiotoxic Plants (Digitalis, Taxus, Aconitum).

相關指南¶

• 中毒急救與毒物控制分診
• 食物中毒、急性胃腸炎、口服補液
• Botulism, shellfish paralysis, ciguatera, and scombroid poisoning
• 癲癇發作和癲癇持續狀態急救
• 成人心肺復甦術和人工呼吸
• Emergency numbers by country