Myotoxic Mushroom Poisoning in Thailand: Clinical Characteristics and Outcomes

Figures & data

Table 1 Clinical Characteristics of the Patients (41 Patients)

Characteristics	Value
Age (year), mean ± SD	48.85 ± 16.02
Season
-Rainy	24 (58.54)
-Winter	9 (21.95)
-Summer	8 (19.51)
Onset of gastrointestinal symptoms after consuming mushrooms (h) (27 cases)–median (min–max)	2 (0.17–24)
Onset of myalgia after consuming mushrooms (h) (15 cases)–median (min–max)	24 (3–96)
Onset of dark urine after consuming mushrooms (h) (16 cases)–median (min–max)	48 (2–120)
Time to hospital after consuming mushrooms (h) median (min–max)	21 (2–120)

Table 2 Presenting Symptoms of the Patients (41 Patients)

Symptoms	Number (%) of Patients
Nausea/vomiting	35 (85.4)
Abdominal pain	26 (63.4)
Myalgia	19 (46.3)
Abnormal dark urine	18 (43.9)
Diarrhoea	14 (34.1)
Dizziness	8 (19.5)
Dyspnoea	8 (19.5)
Chest pain	7 (17.1)
Motor weakness	1 (2.4)
Hiccough	1 (2.4)

Table 3 Clinical Features of Patients with Rhabdomyolysis (33 Patients) During Hospitalisation

Clinical Features Reported (Number of Cases with Recorded Data)	Number (%) of Patients
Elevated AST and ALT	32 (97)
AKI	17 (51.5)
Elevated cardiac enzymes
- Troponin (I or T) (17 cases)	15 (88.2)
- CK-MB (14 cases)	14 (100)
Hyperkalaemia (30 cases)	10 (33.3)
Abnormal chest X-ray (20 cases)	13 (65)
Abnormal electrocardiogram (20 cases)	13 (65)
Abnormal echocardiogram (4 cases)	3 (75)

Abbreviations: AST, aspartate aminotransferase; ALT, alanine transaminase; AKI, acute kidney injury; CK-MB, creatine kinase-MB.

Table 4 Laboratory Findings for Patients with Rhabdomyolysis (33 Patients)

Finding	Result
Initial CPK results (U/L), median (min–max)	31,145 (1221–284,720)
Maximum CPK results (U/L), median (min–max)	47,861 (8616–330,000)
Initial AST results (IU/L), median (min–max)	627 (33–8066)
Maximum AST results (IU/L), median (min–max)	1358 (69–8066)
Initial ALT results (IU/L), median (min–max)	222 (30–4080)
Maximum ALT results (IU/L), median (min–max)	464 (32–4080)
Initial creatinine results (mg/dL), median (min–max)	0.90 (0.36–3.60)
Maximum creatinine results (mg/mL), median (min–max)	1.31 (0.36–9.96)
Initial CK-MB results (U/L) (14 cases), median (min–max)	1602 (50–6443)
Maximum CK-MB results (U/L) (14 cases), median (min–max)	1770.5 (50–7649)
Initial potassium results (mmol/L) (30 cases), mean ± SD	4.3 ± 0.7
Maximum potassium results (mmol/L) (30 cases), mean ± SD	4.7 ± 1.0
Initial WBC results (cells/mm^3) (22 cases), mean ± SD	14,730.5 ± 4952.8

Abbreviations: CPK, creatine phosphokinase; AST, aspartate aminotransferase; ALT, alanine transaminase; CK-MB, creatine kinase-MB; WBC, white blood cell.

Table 5 Differences in Clinical Characteristics and Laboratory Findings Between Patients Who Survived and Patients Who Died for Patients with Rhabdomyolysis (33 Patients)

Clinical Characteristic or Laboratory Finding	Patients with Rhabdomyolysis
	Survived (22)	Died (11)	P-value
Age (years), mean ± SD	50.09 ± 14.20	58.45 ± 12.41	0.107
Sex (%)
Male	10 (45.5)	6 (54.5)	0.622
Female	12 (54.5)	5 (45.5)
AKI (35 cases) (%)	6 (27.3)	11 (100)	<0.001
Shock during hospitalisation (%)	5 (22.7)	6 (54.5)	0.117
Hyperkalaemia during hospitalisation (32 cases) (%)	2 (of 20) (10)	8 (of 10) (80)	<0.001
Initial CPK results (IU/L), median (min–max)	27,882.5 (1221–284,720)	39,157 (2746–179,506)	0.492
Maximum CPK results (IU/L), median (min–max)	36,245.5 (8616–330,000)	86,544 (34,449–179,506)	0.029
Initial AST results (IU/L), median (min–max)	709 (51–8066)	200 (33–4083)	0.456
Maximum AST results (IU/L), median (min–max)	1141 (538–8066)	2157 (69–4083)	0.593
Initial ALT results (IU/L), median (min–max)	225.5 (30–4080)	76 (30–1103)	0.302
Maximum ALT results (IU/L), median (min–max)	460 (135–4080)	464 (32–1791)	0.819
Maximum CK-MB results (IU/L), median (min–max)	1313.5 (300–2800)	3018.5 (50–7649)	0.439
Initial potassium results (mmol/L), mean ± SD	4.03 ± 0.46	4.68 ± 0.85	0.045
Maximum potassium results (mmol/L), mean ± SD	4.25 ± 0.74	5.60 ± 0.98	<0.001
Initial creatinine results (mg/dL), median (min–max)	0.84 (0.36–3.11)	1.31 (0.58–3.60)	0.054
Maximum creatinine results (mg/dL), median (min–max)	0.84 (0.36–9.96)	2.46 (1.31–7.70)	0.001

Abbreviations: AKI, acute kidney injury; AST, aspartate aminotransferase; ALT, alanine transaminase; CPK, creatine phosphokinase; CK-MB, creatine kinase-MB.