Muscarinic Syndrome

Muscarine syndrome is a type of mushroom poisoning. The symptoms typical of muscarinic syndrome appear a few minutes after the consumption of the corresponding mushrooms. This includes both vegetative and neurological symptoms that indicate an impairment of the autonomic nervous system. The muscarinic syndrome can lead to death and is therefore a great danger, especially for mushroom pickers.

Muscarinic Syndrome

What is Muscarinic Syndrome?

Even the name of the syndrome indicates that the substance muscarine is the responsible toxin. Muscarine is a so-called parasympathomimetic that is very similar in structure to acetylcholine. For this reason, the active substance is able to bind to the same receptor of the parasympathetic nervous system. See electronicsmatter for Hydrocephalus Definition.

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

Muscarine was first scientifically identified in fly agarics in 1869. Since toadstools lead to similar neurological symptoms, researchers have long assumed that toadstools can also cause muscarinic syndrome. However, it was later discovered that other toxins are present in fly agarics, namely muscimol and ibutenoic acid.

However, the concentration of muscarine in fly agaric is far too low to trigger poisoning such as muscarine syndrome. On average, the muscarinic content in fly agaric mushrooms is about 200 times lower than in the responsible species of toadstools. The symptoms of muscarinic syndrome show up quickly after eating the mushrooms. In many cases, they appear just a few minutes after they have been eaten, but after three hours at the latest.


The cause of muscarinic syndrome lies in the substance of the same name, which is found in some types of mushrooms. In the majority of cases, these are small funnels, which are usually white in color. Some crack fungi also trigger muscarinic syndrome. On the other hand, the fly agaric contains only traces of the toxin muscarine, although it was named after this substance.

For mushroom pickers, the risk arises primarily when collecting cloves. Because here there is a slight risk of confusion with funnel lice. Collecting May Mushrooms is also problematic, as they are sometimes confused with Brick Red Crack Mushrooms. Intoxicating mushrooms are sometimes confused with the terrestrial crack mushroom, which also contains muscarine.

Symptoms, Ailments & Signs

As part of the muscarinic syndrome, there are numerous different symptoms and complaints that are typical of the poisoning. In most cases, the first symptoms appear just a few minutes after eating the mushrooms and after two to three hours at the latest. Immediately after eating the mushrooms there is an increased production of saliva and lacrimal fluid coupled with outbreaks of sweating, vomiting and nausea.

In addition, blurred vision and shortness of breath often occur while the heart rate slows. These symptoms are extremely uncomfortable for those affected and sometimes lead to serious complications. However, an antidote with good efficacy exists.

This is atropine, the poison of the deadly nightshade. If this antidote is administered quickly, the symptoms of muscarinic syndrome disappear within a few minutes. If the antidote is not immediately available, there is a risk of death from cardiovascular failure.

Since muscarine has a similar effect to neurotoxins, it influences the autonomic nervous system. It affects the parasympathetic nervous system, which is why the muscarinic syndrome is associated with corresponding symptoms. These include, for example, visual disturbances, since the pupils become very narrow (miosis).

In addition, increased sweat is produced (hyperhidrosis). Symptoms of the gastrointestinal tract such as nausea and vomiting appear. Muscarinic syndrome is often accompanied by tremor and a slow pulse. In some cases, blood pressure drops sharply. Breathing becomes difficult as the airways narrow. In addition, many patients panic.

Diagnosis & course of disease

Since muscarinic syndrome is a potentially life-threatening poisoning, treatment is indicated as soon as the syndrome is suspected. If symptoms appear after a mushroom meal, therapy should be initiated immediately.

The substance muscarin can be detected in the serum by a laboratory test. The diagnosis can be confirmed by examining the ingested mushrooms or the vomit. If the antidote atropine is used quickly, the chances of survival are relatively good.


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

It comes to nausea, vomiting and also to fever or sweating. The patient’s resilience decreases and there are problems with coordination or concentration. Muscarinic syndrome can also cause visual disturbances and can also be associated with shortness of breath. The patient may also lose consciousness due to shortness of breath.

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

When should you go to the doctor?

If health problems occur immediately after eating mushrooms, a doctor should be consulted. In the case of nausea, vomiting, feeling unwell or diarrhea, there is an impairment of the organism. If the symptoms persist or increase in intensity, you should see a doctor. Sweating, dizziness, a profuse increase in salivation, and tremors indicate an irregularity that should be investigated and treated.

Paralysis, muscle disorders or a severe drop in circulation must be presented to a doctor. Narrowing of the pupils, increased body temperature and internal weakness are signs of a disorder. Since muscarinic syndrome can lead to premature death in severe cases, a doctor should be consulted in good time. If the situation becomes acute, an emergency service must be alerted. Immediate action is required in the event of a cardiovascular collapse or loss of consciousness. First aid measures must be initiated before the arrival of the emergency doctor. If the person concerned suffers from reduced vision and shortness of breath, a doctor is needed.

Medical help should also be sought as soon as the symptoms occur during or after a visit to a restaurant and no explicit mushroom dish has been eaten. Cooks may have used the crushed mushrooms as a flavor enhancer or seasoning of the menu without the knowledge of the person concerned.

Treatment & Therapy

To treat muscarinic syndrome, if possible, first induce the affected person to vomit the meal. Gastric lavage may be necessary. Then 20 to 40 grams of activated charcoal are administered several times. It is particularly important that the patient is supplied with sufficient liquid. The antidote atropine is usually given intravenously. The therapy is accompanied by an ECG control.

Outlook & Forecast

In the case of muscarine poisoning, the prognosis depends primarily on the amount of the substance consumed, the condition of the patient and how quickly and comprehensively the intervention is carried out. If you suspect that you have eaten a mushroom containing muscarine, you should take immediate action. This includes vomiting and gastric lavage, as well as administering activated charcoal to help absorb the toxin. In the case of very severe symptoms of poisoning, atropine may have to be administered as an antagonist.

If such measures are ignored, severe muscarinic intoxication can lead to death from cardiac or respiratory arrest. If treatment is started in good time, the symptoms of poisoning can almost always be resolved within 24 hours. Permanent damage is not to be expected.

Mild muscarinic poisoning is treated with gastric lavage and administration of activated charcoal and is often overcome within 2-4 hours. If the first gastric lavage takes place within an hour after mushroom consumption, this is usually sufficient as a treatment measure. Lighter poisonings usually end after two hours even without medical treatment. However, since it is never possible to reliably estimate in advance how severe the poisoning will ultimately be, a doctor should be consulted immediately in any suspected case.


Since the muscarinic syndrome represents a threatening mushroom poisoning, preventive measures and knowledge are of great importance for mushroom pickers. If you are unsure about the type of mushroom, do not eat it. Uncertainties when collecting mushrooms can be eliminated, for example, by experienced mushroom connoisseurs.


In most cases, those affected with muscarinic syndrome have either no or only very few direct follow-up measures available. In the case of this disease, a doctor must be consulted at a very early stage to prevent further complications or other symptoms. If left untreated, the disease leads to the death of the patient.

Such poisoning is a serious illness that must be treated by a doctor in any case. As soon as the first signs and symptoms appear, those affected should consult a doctor. Furthermore, in the case of muscarinic syndrome, the intake of the respective mushrooms should be interrupted in order not to further poison the body.

Gastric lavage can also be performed. After such an operation, it is advisable to rest and recover. You should refrain from exertion or other stressful or physical activities. Likewise, only light food should be taken so as not to overwhelm the stomach.

In many cases, those affected by muscarinic syndrome are also dependent on the help and care of their own families. If the disease is recognized and treated in good time, there are usually no further complications and no reduced life expectancy for the person affected.

You can do that yourself

If signs of muscarinic syndrome are noticed, the victim should be promptly induced to vomit. An ambulance must then be called or the person concerned must be taken to a hospital immediately, where gastric lavage and drug treatment can be carried out.

After the initial treatment, the patient should take it easy. The diet must be changed in the first few days after the poisoning. In order not to put additional strain on the stomach, bland foods and lean meat should be consumed. First of all, it is important to avoid irritating foods and luxury foods. Accompanying this, the medication prescribed by the doctor must be taken in order 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.

Other self-help measures are limited to protecting the body and especially the gastrointestinal tract. In addition, you should be more careful when collecting mushrooms in the future. If you are unsure about the type of mushrooms you have collected, you should refrain from eating them. The poisonous mushrooms already collected must be disposed of in any case.