Section 1 — Bilingual Triage Calculator / Calculadora de Triaje Bilingüe
Rapid Mushroom Poisoning Risk Stratification
Estratificación rápida del riesgo de intoxicación por hongos
Section 2 — Inpatient Lab Monitoring Schedule / Esquema de Monitoreo de Laboratorio
Baseline at Admission (T-0) / Ingreso (T-0)
Full Metabolic Panel
Electrolytes, glucose, BUN, creatinine, bicarbonate
CBC / Biometría hemática completa
With differential
Coagulation / Coagulación
PT / INR
Liver Function Tests / Pruebas hepáticas
ALT, AST, Total & Direct Bilirubin, Alkaline Phosphatase
Urinalysis / Examen General de Orina
With microscopy
Hepatic Panel — Amatoxin Suspected Cases / Casos Sospechosos de Amatoxina
Markers / Marcadores
ALT / AST, PT / INR, Total & Direct Bilirubin
Frequency / Frecuencia
Repeat every 6 hours from T+6 to T+24
Action Threshold
If INR > 1.5 or ALT doubles at T+24 → Initiate urgent liver transplant triage
🔴 Liver Transplant Triage Criteria — Criterios de Trasplante Hepático
- PT > 100 seconds (INR > 6.0)
- OR combination: Creatinine > 3.4 mg/dL + arterial pH < 7.30 + Grade III / IV Hepatic Encephalopathy
Renal Panel — Orellanine Suspected Cases / Casos Sospechosos de Orelanina
Markers / Marcadores
Serum Creatinine, BUN, Fractional Excretion of Sodium (FeNa)
Frequency — First 72 hours
Every 12 hours for 72 hours
Frequency — Days 4–7
Daily — monitor for delayed interstitial nephritis
Section 3 — Differential Diagnosis Grid / Grilla de Diagnóstico Diferencial
| Clinical Picture / Cuadro Clínico | Closest Differential / Diagnóstico Diferencial | Key Distinguishing Factor / Factor Distintivo Clave |
|---|---|---|
| Hyper-acute diarrhea / vomiting < 3 hours | Bacterial food poisoning / Viral gastroenteritis | Mushroom onset faster (30–90 min). Food poisoning clusters in groups sharing same meal, onset 4–12 hours. |
| Salivation, miosis, bradycardia, wheezing < 2 hours | Organophosphate / Carbamate insecticide exposure | Muscarine: no cholinesterase depression on labs, no muscle fasciculations, no chemical odor. |
| Severe delayed diarrhea + temporary improvement 6–24 hours | Vibrio cholerae / C. difficile colitis | Amatoxin: distinct 6–12 hour asymptomatic window. Foraging history 24 hours prior. Rapid transaminase elevation after false recovery. |
| Agitation, hallucinations, tachycardia, warm skin < 2 hours | Amphetamine / cocaine overdose / Anticholinergic poisoning | Psilocybin: pupils dilated but skin remains MOIST (dry skin = anticholinergic). No chest pain or severe hypertension. |
Section 4 — Bilingual Discharge Instructions / Instrucciones de Alta Bilingüe
ESPAÑOL — Instrucciones de Alta
⚠ Regrese a urgencias INMEDIATAMENTE si presenta:
- Ictericia (ojos o piel amarilla)
- Reaparición de vómito o diarrea acuosa
- Disminución o ausencia de orina
- Confusión o debilidad extrema
- Temblores musculares
ENGLISH — Discharge Instructions
⚠ Return to emergency room IMMEDIATELY if:
- Jaundice (yellowing of eyes / skin)
- Return of vomiting or watery diarrhea
- Decreased or absent urination
- Confusion or extreme weakness
- Muscle tremors