Muskarin syndrome is a type of fungal poisoning. Only a few minutes after the consumption of the corresponding fungi, symptoms typical of muscarine syndrome appear. These include both vegetative and neurological complaints that indicate an impairment of the autonomic nervous system. The muscarine syndrome may lead to death and therefore represents a great danger especially for mushroom pickers.

What is muscarinic syndrome?

Even the name of the syndrome indicates that the substance muscarine represents the responsible toxin. Muskarin is a so-called parasympathomimetic which is very similar in structure to acetylcholine. For this reason, the active ingredient is able to bind to the same receptor of the parasympathetic nervous system.

The corresponding receptors are also referred to as muscarinic acetylcholine receptors. The difference and the cause of the complaints, however, is that the so-called acetylcholinesterase can not break down the muscarine. As a result, a permanent irritation of the parasympathetic nervous system, resulting in the typical and sometimes life-threatening symptoms of muscarine syndrome.

The substance Muskarin was scientifically proven in 1869 for the first time in toadstools. Since toadstools lead to similar neurological complaints, research has long assumed that fly agaric can also cause muscarine syndrome. However, later it has been discovered that toadstools have other toxins, namely muscimol and ibuthenic acid.

The concentration of Muskarin in the fly agaric is far too low, however, to cause a poisoning like the muscarine syndrome. On average, the content of Muskarin in toadstools is about 200 times lower than in the responsible species of cracked mushrooms. The symptoms of muscarine syndrome appear rapidly after eating the mushrooms. They occur in many cases already a few minutes after their consumption, but at the latest after three hours.


The cause of the muscarine syndrome is due to the substance of the same name, which occurs in some types of fungi. In the majority of cases, these are small funnels, which usually have a white color. Some crack fungi trigger the muscarine syndrome. By contrast, the fly agaric contains only traces of the toxin muscarin, although it was named after this substance.

For mushroom pickers, the risk arises especially when clove nerds are collected. Because there is a slight likelihood of confusion with Trichtlingen. The collection of maize mushrooms is problematic, as they are sometimes confused with brick red cracker mushrooms. In some cases, toadstools are mistaken for the Erdblättrigen Risspilz, which also contains Muskarin.

Symptoms, complaints & signs

As part of the muscarine syndrome numerous symptoms and symptoms that are typical of the poisoning show up. The first symptoms appear in most cases already a few minutes after the consumption of the mushrooms and at the latest after two to three hours. Thus, immediately after the mushroom meal, there is an increased production of saliva and tears, accompanied by sweating, vomiting and nausea.

In addition, visual disturbances and shortness of breath often occur while the pulse slows down. These symptoms are extremely uncomfortable for the affected person and sometimes cause serious complications. However, an antidote with good effectiveness exists.

These are atropine, the poison of the belladonna. If administered quickly, the symptoms of muscarine syndrome disappear within a few minutes. If the antidote is not immediately available, there is a risk of death from cardiovascular failure.

Because muscarinic acts like neurotoxins, it affects the autonomic nervous system. It affects the parasympathetic nervous system, which is why the muscarine syndrome is associated with corresponding symptoms. These include, for example, blurred vision, as the pupils narrow much (miosis).

In addition, more sweat is produced (hyperhidrosis). It shows complaints of the gastrointestinal tract such as nausea and vomiting. The muscarine syndrome is often accompanied by tremor and a slow pulse. In some cases, the blood pressure drops sharply. Breathing is made more difficult as the airways narrow. In addition, many patients panic.

Diagnosis & disease course

Since muscarine syndrome is a potentially life-threatening poisoning, treatment is indicated in suspected syndrome. If symptoms appear after a mushroom meal, a therapy must be initiated immediately.

Through a laboratory test the substance Muskarin is detectable in the serum. The diagnosis can be confirmed by studies of the consumed mushrooms or the vomit. If the antidote atropine is used quickly, the chances of survival are relatively good.


Muskarin syndrome can, in the worst case, lead to the death of the patient. For this reason, serious poisoning must definitely be examined by a doctor. Without treatment, it can also lead to serious consequential damage to the internal organs of the person concerned. In most cases, patients suffer from the symptoms and symptoms of typical poisoning from muscarine syndrome.

It comes to nausea, vomiting and also to fever or sweats. The resilience of the person affected decreases and there are disturbances of coordination or concentration. Also, visual disturbances can occur due to muscarine syndrome and continue to be associated with respiratory distress. Due to the shortness of breath the affected person can also suffer a loss of consciousness.

In many cases, death by heart failure continues. Those affected suffer from tremors and a severely slowed pulse. The treatment of muscarine syndrome must always be acute. In this case, the death of the person affected can be avoided. In some cases, poisoning can also damage the internal organs. Whether this leads to a reduction in life expectancy can not be generally predicted.

When should you go to the doctor?

If health problems occur immediately after the consumption of fungi, a doctor should be consulted. In case of nausea, vomiting, malaise or diarrhea, the organism is impaired. If the symptoms persist or increase in intensity, a visit to the doctor should be made. Sweats, dizziness, a sharp increase in salivation, and tremors indicate an irregularity that should be investigated and treated.

Paralyzes, muscle disorders or a strong drop in the circulation should be presented to a doctor. A narrowing of the pupils, an increased body temperature and an internal weakness are signs of a disorder. Since the muscarine syndrome in severe cases can lead to premature death of the person concerned, a doctor should be consulted in good time. If it comes to an acute condition, an emergency service is to be alerted. With a breakdown of the cardiovascular system or a loss of consciousness, there is an immediate need for action. First aid measures must be initiated until the arrival of the emergency physician. If the person suffering from a diminished vision and a shortness of breath, a doctor is needed.

Medical assistance is also available as soon as the complaints occur during or after a restaurant visit and no explicit mushroom dish was consumed. Cooks may have used the mushrooms minced as a flavor enhancer or seasoning the menu without the knowledge of the person concerned.

Treatment & Therapy

In order to treat the muscarine syndrome, the affected person should, as far as possible, first vomit the meal. Maybe a gastric lavage is necessary. Subsequently, several times each 20 to 40 grams of activated carbon are administered. It is particularly important that the patient is provided with sufficient fluid. The antidote atropine is usually administered intravenously. The therapy is accompanied by an ECG control.

Outlook & Forecast

In the case of muscarinic poisoning, the prognosis depends primarily on how much of the substance was consumed, how good the patient's constitution is, and how quickly and comprehensively intervened. Already with the suspicion on consumption of a muscarinhaltigen mushroom immediate measures should be taken. These include vomiting and gastric lavage as well as the administration of activated carbon to absorb the toxin. For very severe signs of intoxication, atropine may need to be administered as an antagonist.

If such measures are ignored, severe muscarinic intoxication can lead to death due to cardiac or respiratory arrest. With timely initiation of treatment, the symptoms of poisoning can almost always be stopped within 24 hours. Permanent damage is not expected.

Light muscarinic poisoning is treated with gastric lavage and charcoal and is often overcome within 2-4 hours. If the first gastric lavage takes place within an hour after the consumption of the fungus, this is usually sufficient as a treatment measure. Easier poisoning usually ends after two hours without medical treatment. However, since it is never possible to predict in advance how severe a poisoning will ultimately be, a doctor should be consulted immediately in every suspected case.


Since muscarine syndrome is a menacing mushroom poisoning, preventative measures and knowledge are of great importance to mushroom pickers. If there is any uncertainty about the nature of a fungus, its consumption should be foreseen. Ambiguities in collecting mushrooms can be eliminated, for example, by experienced mushroom connoisseurs.


Affected Musculin syndrome in most cases, either no or very few measures of direct follow-up available. With this illness a doctor must be looked up very early, so that it does not come to further complications or to other complaints. Untreated, the disease leads to death of the patient.

Such poisoning is a serious condition that must be treated by a doctor in any case. Even at the first signs and symptoms, sufferers should consult a doctor. In addition, in Muskarin syndrome the uptake of the respective fungi should be interrupted so as not to further poison the body.

It can also be done a gastric lavage. After such an intervention, it is recommended to rest and recover. It is to be foreseen from efforts or other stressful or physical activities. Likewise, only light food should be taken so as not to overburden the stomach.

In many cases, those affected by muscarine syndrome also depend on the help and care of their own family. If the disease is recognized and treated in time, it usually does not lead to further complications and also to a reduced life expectancy of the person concerned.

You can do that yourself

If signs of muscarinic syndrome are noticed, vomiting must be promptly induced. Subsequently, an emergency doctor must be called or the person affected must be taken immediately to a hospital, where a gastric lavage and a drug treatment can be performed.

After the initial treatment, the patient should first spare. The diet must be changed in the first days after the poisoning. In order not to burden the stomach additionally, especially light food and lean meat should be consumed. At first you have to do without lovely food as well as luxury food. Accompanying this, the medicines prescribed by the doctor must be taken to avoid a relapse. If unusual symptoms are noticed, the responsible doctor must be informed immediately. After a few days, the symptoms should have subsided.

Further self-help measures are limited to sparing the body and in particular the gastrointestinal tract. In addition, the future of mushroom picking should be more cautious. In case of uncertainty about the nature of the mushrooms collected should be refrained from eating. The already collected poisonous mushrooms must be disposed of in any case.

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