For Emergency Physicians, Toxicologists, EMS & Poison Control
This guide covers the 9 most dangerous toxic mushroom species and species complexes in Yukon and the Northwest Territories — including tundra-specific hazards not found in southern guides. Protocols are calibrated for remote nursing stations, fly-in communities, and the extended transport times characteristic of the territories. A dietary history of two weeks or longer is mandatory for all suspected cases — Orellanine onset can be delayed up to 14 days.
Designed for emergency departments, urgent care, EMS, nursing stations, and poison control consultation across the Yukon Territory, Northwest Territories, and Nunavut.
| Species | Tier | Toxin | Onset | Key Intervention |
|---|---|---|---|---|
| Amanita virosa complex (Destroying Angel) | Tier 1 | Amatoxins | 6–24 h Phase 1; Phase 2 false recovery at 24–48 h | IV fluid, NAC, Silibinin, hepatology |
| Galerina marginata (Deadly Galerina) | Tier 1 | Amatoxins | 6–24 h | Full Destroying Angel protocol |
| Cortinarius spp. — Orellanine group | Tier 1 | Orellanine | 3–14 days | Nephrology, hemodialysis, 2-week dietary history |
| Gyromitra esculenta (False Morel) | Tier 2 | Gyromitrin/MMH | 6–12 h | Pyridoxine IV, methylene blue |
| Arctic Inocybe complex | Tier 2 | Muscarine | 15–30 min | Atropine — titrate to bronchosecretion drying only |
| Tricholoma equestre (Man on Horseback) | Tier 2 | Myotoxin | 24–72 h after repeated meals | Aggressive IV diuresis, CK monitoring |
| Clitocybe rivulosa (Ivory Funnel) | Tier 2 | Muscarine | 15–30 min | Atropine — titrate to bronchosecretion drying only |
| Amanita muscaria (Fly Agaric) | Tier 3 | Ibotenic acid / Muscimol | 30 min–2 h | Supportive. DO NOT give Atropine. |
| Lycoperdon spp. (Immature Puffballs) | Tier 3 | — | Variable | Field ID check: slice lengthwise for Amanita button exclusion |
Treatment Protocol:
1. Aggressive IV fluid resuscitation.
2. Multi-dose activated charcoal to interrupt enterohepatic circulation of amatoxin.
3. IV Silibinin (Legalon SIL) if available — contact regional pharmacy.
4. NAC Protocol — Adult: loading dose 150 mg/kg IV over 60 min, then 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours.
5. Pediatric NAC: same weight-based dosing.
• Capillary refill target: under 2 seconds
• Urine output target: 1–2 mL/kg/hour
• Hypoglycemia correction: D10W 2–5 mL/kg IV bolus
• Potassium monitoring: correct hypokalemia aggressively
Monitoring: LFTs and INR every 6–8 hours. Early hepatology consult. Liver transplant evaluation initiated if INR rising on Day 2–3.
Regional Referral: University of Alberta Hospital Liver Transplant Team.
Packed RBC transfusion if PCV drops below 20–25% or plasma appears visibly pink.
Clinical Note: Galerina marginata is extremely common on decaying spruce and birch logs throughout Yukon and NWT boreal forest. Small size makes it easy to overlook or mix with harvested edible species. Any case of GI illness in a forager who collected wood-decaying mushrooms must include Galerina on the differential.
Treatment: Early nephrology consultation. Serial creatinine tracking. Hemodialysis or CRRT as indicated. Monitor for permanent renal failure. No specific antidote exists — management is supportive with early aggressive renal replacement therapy.
🔍 Three-Point Field Key — False Morel vs True Morel
- Cap surface: False Morel has irregular brain-like saddle-shaped folds. True Morel has regular honeycomb pits with vertical ridges.
- Stem attachment: False Morel cap hangs free at the edges. True Morel cap is fully fused to the stem all the way down.
- Interior (slice lengthwise): False Morel is cottony and chambered. True Morel is completely hollow from stem to cap.
Treatment:
Pyridoxine (Vitamin B6) IV — Adult: 25 mg/kg, strict 5 g ceiling. Pediatric: 25 mg/kg, strict cumulative daily ceiling 5 g.
Methylene blue 1–2 mg/kg IV for methemoglobinemia.
Liver transplant evaluation in severe cases.
Treatment: Atropine 0.5–2 mg IV — titrated to drying of bronchial secretions only. Do NOT titrate to heart rate or pupil size.
Treatment: Aggressive IV fluid diuresis — Adult: 200–300 mL/hour. Pediatric: 10–20 mL/kg/hour. CK monitoring every 6–8 hours. Nephrology consult. Urine alkalinization with sodium bicarbonate (target urine pH 6.5–7.5). Monitor for secondary AKI from myoglobinuria.
Treatment: Atropine 0.5–2 mg IV titrated to drying of bronchial secretions only — not heart rate or pupil size. Airway management if bronchospasm severe.
Treatment: Supportive care. Benzodiazepines for agitation or seizures. Quiet, sensory-reduced environment. Recovery typically complete within 24 hours.
🧪 Sample Preservation Checklist — Collect Before Patient Arrives
- Wrap in paper or foil — never plastic (plastic accelerates decomposition and degrades toxin identification)
- Refrigerate immediately — do not freeze
- Preserve entire specimen including base and any cup structure (volva)
- Document collection coordinates and host tree species