By the time anyone is ill the species is usually unknown, so poisonings are classified by SYNDROME. The single most useful discriminator is the delay between the meal and the first symptom, and it sorts them almost perfectly, in the opposite direction to instinct.
Muscarine
Sweating, streaming eyes and nose, heavy salivation, blurred and pin-point vision, abdominal cramps, a slowed heart and, in serious cases, difficulty breathing. Clinicians remember it by the initials SLUDGE.
Attacks
The parasympathetic nervous system
Treatment
Atropine is a specific and rapidly effective antidote, which makes this one of the few mushroom poisonings with a real answer. Get to a hospital and say the word muscarine.
20 minutes to 2 hours after drinking, and the mushroom may have been eaten days earlier
Coprine
Sudden flushing of the face and neck, a pounding heart, throbbing headache, nausea and a powerful sense of impending doom. It is the same mechanism as the drug disulfiram used to treat alcoholism.
Attacks
Alcohol metabolism
Treatment
Supportive. Avoid alcohol entirely for at least three days after eating the mushroom.
A grab-bag of unrelated compounds, most of them still unidentified
Nausea, forceful and repeated vomiting, cramps and diarrhoea, sometimes bloody. It is genuinely violent and people are frightened by it.
Treatment
Rehydration, and anti-emetics if needed. Supportive rather than specific.
Ibotenic acid and muscimol
Confusion, agitation, distorted perception of size and distance, euphoria alternating with deep sedation, nausea and vomiting, muscle twitching, and in larger doses seizures and coma.
Attacks
The central nervous system
Treatment
Supportive: a quiet room, observation, and sedation if agitation is dangerous. Not something to manage at home.
1 to 3 hours, but only after previous meals have sensitised you
An immune reaction rather than a toxin as such
Vomiting and diarrhoea, then pallor, jaundice, dark urine and collapse as antibodies destroy the eater's own red cells.
Attacks
Red blood cells, through the immune system
Treatment
Hospital. Steroids, transfusion and plasma exchange. Not something any home remedy touches.
Gyromitrin, hydrolysed in the body to monomethylhydrazine
Bloating, nausea and vomiting, then severe headache, vertigo and exhaustion. In serious cases jaundice, destruction of red blood cells, seizures and coma.
Attacks
The liver, red blood cells and the nervous system
Treatment
Hospital. Pyridoxine, vitamin B6, is used for the neurological effects, which is unusual and specific enough to be worth naming to the clinician.
6 to 24 hours, and the delay is the killer
Amanitin, a cyclic peptide that shuts down RNA polymerase II
Phase one: violent vomiting and cholera-like diarrhoea, 6 to 24 hours after the meal. Phase two: an apparent RECOVERY lasting a day or two, during which people are sometimes discharged from hospital. Phase three: liver failure, jaundice, bleeding, coma.
Attacks
The liver, and then the kidneys
Treatment
Hospital, immediately, and say the word amatoxin. Intravenous fluids, silibinin where available, high-dose penicillin, N-acetylcysteine, and transplant assessment. Time is everything and there is no home management of this.
Orellanine
Nothing at all for days. Then thirst, heavy urination, then falling urine output, nausea, loin pain and the signs of kidney failure.
Treatment
Hospital and renal support. There is no antidote, and the window in which anything preventive could have been done has closed long before anyone feels ill.