Cholinergic syndrome with loss of consciousness due to Amanita poisoning

History and admlssion findings: A 41-year-old patient was found in his fiat in a state of coma. After emergency treatment his vital signs were stable and he was transferred to an acute hospital with possible cannabis intoxica tion. The patient, a hobby gardener, was previously well and had an adversi on to the use of any chemical substances. The main symptom showed a choline rgic syndrome with deep coma. We assumed plant ingestion because of the cli nical picture and history. Investigations: The laboratory results were within normal limits apart from a slight rise of the serum creatinine kinase level. The electrocardiogram showed a bradycardia. A drug-screening could not be performed. Treatment and course: The differential diagnosis of plant alkaloids or mush room toxins were considered due to possible plant ingestion and a cholinerg ic syndrome. Later the toadstool (Amanita muscaria) was found. After treatm ent oft the cholinergic: syndrome with high doses of atropine primary poiso n elimination was performed. 24 hours later the patient awoke from his coma . Visual hallucinations persisted for a few days. No organic damage due to the intoxication was found. Conclusion: Toxic mushroom ingestion can produce a variety of clinical pict ures. Most commonly an anticholinergic syndrome is found, but this was not the case in this patient. The effect of the poison depends on the amount an d the preparation, so that no reliable outcome predicition can be made. The drug,>>poisonous mushroom<< is legal and hallucinogenic substances are tre ndy. As a result clinical signs like those described here will have? to be expected in the future.