Zusammenfassung
Anamnese und klinischer Befund: Ein 41-jähriger Patient wurde in seiner Wohnung komatös aufgefunden und nach notärztlicher
Versorgung mit stabilen Vitalfunktionen unter dem Verdacht auf eine Cannabisintoxikation
in die Klinik aufgenommen. Der bisher gesunde Patient sei Hobbygärtner und hege eine
Abneigung gegen „Chemie“. Leitsymptom war ein cholinerges Syndrom mit tiefem Koma.
Wir vermuten aufgrund des klinischen Erscheinungsbildes und der Anamnese eine Intoxikation
durch Pflanzeningestion.
Abstract
History and admission findings: A 41-year-old patient was found in his flat in a state of coma. After emergency treatment
his vital signs were stable and he was transferred to an acute hospital with possible
cannabis intoxication. The patient, a hobby gardener, was previously well and had
an adversion to the use of any chemical substances. The main symptom showed a cholinergic
syndrome with deep coma. We assumed plant ingestion because of the clinical 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 mushroom toxins were considered
due to possible plant ingestion and a cholinergic syndrome. Later the toadstool (Amanita
muscaria) was found. After treatment oft the cholinergic syndrome with high doses
of atropine primary poison 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 pictures. 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 and the preparation, so that no reliable
outcome prediction can be made. The drug "poisonous mushroom" is legal and hallucinogenic
substances are trendy. As a result clinical signs like those described here will have
to be expected in the future.
