The Poison Lab – Détails, épisodes et analyse

As reports of severe illness and death come in, the Bozeman outbreak moves from medical mystery to full public health investigation. Local and state investigators race to identify the source, shut down the risk, interview patients, collect food samples, and figure out whether anyone else could still be in danger.

The early signal points toward one unlikely ingredient: morel mushrooms. But for toxicologists, that raises more questions than answers. Morels are supposed to be edible. Rapid vomiting and diarrhea usually suggest foodborne illness, not a deadly mushroom poisoning. So investigators have to ask the question that will drive the rest of the series: is the morel really the culprit, or is something else hiding in the meal?

In Episode 2 of A Morel Dilemma, we meet the public health team on the front lines, hear how the outbreak was contained, and begin testing the first theories behind what made diners so sick.

A deadly outbreak begins with a single meal at a sushi restaurant in Bozeman, Montana. Within hours, diners develop severe nausea, vomiting, and diarrhea. Some collapse. Two people die. At first, it looks like food poisoning, but investigators quickly notice one strange ingredient connecting many of the sick patients: morel mushrooms.

In the first episode of A Morel Dilemma, we meet the people caught in the earliest moments of the outbreak and begin following the investigation as it unfolds in real time. What starts as a suspected restaurant-associated illness quickly becomes a much stranger question: how could a prized edible mushroom, eaten for centuries, suddenly be linked to death?

This is not a retrospective summary. It is the beginning of a poisoning mystery, told the way investigators experienced it: with urgency, uncertainty, and more questions than answers.

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 • Poisonous Fungus Among Us | Full Children’...  

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 • Poisonous Fungus Amongus Highlights Reel  

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 • Poisonous Fungus Amongus- Children's Book ...  

From the mind of a toxicologist who treats real mushroom poisonings alongside doctors and poison centers comes Poisonous Fungus Amongus—a playful, rhyming adventure into the fascinating world of poisonous mushrooms!

Inside, readers will find a colorful introduction to mushroom anatomy and ecology—learning the parts of a mushroom and discovering helpful hints for safe foraging and identifying dangerous look-alikes. Every species featured in these pages is a real poisonous mushroom, brought to life through vivid illustrations and engaging verse.

This beautifully illustrated book goes beyond the basics, exploring how mushrooms grow, reproduce, and take shape in nature—from tiny spores to sprawling mycelium to the fruiting bodies we find in forests and fields.

Through rhymes and clear explanations, readers learn to recognize essential mushroom features—caps, gills, pores, rings, bulbs (volvas), veils, warts, scales, spore prints, and gill types like free, adnate, and decurrent. Each detail helps distinguish the edible from the toxic—and shows how some features can fool us!

The story encourages safe and curious observation: note each feature, dig gently to look for bulbs, observe nearby trees and seasons, and check for bruising or color changes. Along the way, readers also discover fungi’s hidden ecological roles, from tree-nurturing mycorrhizae to the saprotrophs that recycle the forest floor.

With rhythm, rhyme, and a spark of scientific wonder, Poisonous Fungus Amongus blends accuracy with imagination—inviting kids and adults alike to explore and respect the natural world, while learning that curiosity and caution must always grow together when it comes to mushrooms.

Perfect for young readers, nature lovers, teachers, and families who want to explore the mysterious and magical world of fungi!

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In this special live episode from the 2025 North American Congress of Clinical Toxicology (NACCT), Ryan takes you inside the conference to hear directly from the researchers themselves. Covering 11 abstracts that span high-stakes management decisions, surprising case reports, and challenges to toxicology dogma, this year’s highlights feature everything from amlodipine overdoses to naturopathic misadventures, metformin-associated blindness, and more. The show kicks off with a foreword from Ryan and Dr. Jon Cole (abstract co-chair for AACT) discussing some of their favorite research from the conference.

If you couldn’t make it to NACCT or just want to catch up on some of the most impactful new research in our field, this episode will give you a front-row seat. Check below for links to the published abstracts, the full list of studies discussed, and timestamps for where you can hear each one.

Link to published abstract manuscript

10:43 #7. Is beta blocker toxicity associated with hypoglycemia?

• Lead author: Dr. Megan Audette, MD

18:17 #237. V-A ECMO as a treatment for vasoplegic shock in amlodipine poisoning: a comparison

• Lead author: Dr. Daniel Tirado, MD

27:59 #247. Blocked but not beaten: ECMO’s role in severe amlodipine toxicity – a poison center case series

• Lead author: Dr. Carlos Saldarriaga, MD

28:18 #26. Amlodipine double-dose therapeutic errors reported to Poison Centers

• Lead author: Johanne Freeman

30:38 #27. Dosing on the edge: unpacking inadvertent amlodipine ingestions reported to a single poison center

• Lead author: Dr. Tiana Patriarca, PharmD

34:03 #292. Intravenous administration of sodium zirconium cyclosilicate resulting in death

• Lead author: Dr. Stephen Thornton, MD

44:16 – #21. Quantitative analysis of amlodipine removal by plasmapheresis

• Guest: Dr. Keahi Horowitz, MD – Acute and Intensive Care Research Award winner

48:33– #23. Relationship between reported ingestion dose and outcome in amlodipine poisoning

• Guest: Dr. Colleen Cowdery, MD

51:37 – #24. Management of severe amlodipine toxicity with high-dose calcium alone

• Guest: Dr. Vincent Ma, MD
• High dose norepinephrine in amlodipine overdose
• Case report of calcium death

56:56– #70. Iatrogenic exposure to long-acting buprenorphine injectable in an opioid-naïve patient

• Guest: Dr. Conor Young, MD

01:00:11 – #182. Left in the dark: a case of blindness in the setting of metformin toxicity

• Guest: Dr. Madison Bombard, MD

01:12:11 – #169. Just because it’s natural doesn’t mean it’s safe: a case of pediatric toxicity from topical and herbal remedies

• Guest: Dr. Aria Darling, MD

01:04:31 – #203. Serotonin syndrome after vaping Moocah

• Guest: Dr. Connor Murphy, MD

01:07:06 – #307. Intravenous ozone autohemotherapy: a retrospective observational case series

• Guest: Nicole McLarty

01:11:25 – #134. Do they really need n-acetylcysteine? Exploratory analysis of outcomes in patients with elevated liver function tests but no detectable acetaminophen

• Guest: Dr. Seth Carroll, PharmD

01:15:33 – #130. Outcomes of acute acetaminophen-poisoned patients treated with and without fomepizole: a Toxic registry study

• Guest: Dr. Jordan Woollum, PharmD

01:21:23 – #295. Evaluation of onset and resolution of complications after chronic methotrexate poisoning

• Guest: Dr. Van Quach, PharmD

01:24:51 – #325. Implications of potassium in salicylate toxicity treated with urinary alkalinization

• Guest: Dr. Andrew Yetka, PharmD

• Stick around to the very end of the episode for a teaser of Stump the Tox and the brand-new game Tox Wavelength, recorded on the train to NACCT. The full episode is available now for supporting members.

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• Full book reading (6 minutes!)

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In this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Joe Kennedy, medical toxicologist at the University of Vermont and consultant for the Northern New England Poison Center. Together they work through real poisoning cases to sharpen toxic differentials, sum up practical resuscitation priorities, and connect first-principles pharmacology to bedside decisions. They also answer listener questions on THAM vs bicarbonate, when to dialyze even with “normal” kidneys, and why rattlesnake antivenom costs so much—plus the real-world logistics of sourcing exotic antivenoms in the U.S.

Dr. Kennedy and Ryan discuss the topics below. Looking for timestamps? Join the subscribed feed!

• Case set #1: Shock with hyperglycemia, big pupils, and probably NOT what you think it is.
• Case set #2: Massive bleeding after gas-station “herbal” products
• Case set #3: Refractory wide-complex rhythms in a teen overdose
• Case set #4: Sudden collapse at a hog farm- (SPOLIER) Recent outbreak of deaths as related to case 4

Want the cases summarized and sent to you so you can come up with your differential before the show? SIGN UP FOR THE NEWS LETTER!

Listener Q&A

• THAM vs bicarbonate (closed vs open buffering; “breathe for bicarb, tinkle for THAM”)
• Why dialyze if the kidneys work? (EXTRIP-style thinking, gradients, and properties)
• Snake antivenom pricing & how zoos help hospitals obtain non-U.S. antivenoms

Call outs from the show

• NACCT Abstracts!
• Clover coagulopathy!
• THAM VS BICARB Electrolytes
• Potato quality video of dialysis from Ryan
• Article on snake antivenom costing >200,000 for one patient
• Article on exotic antivenom procurement
• Case report Ryan published on treating blue Indonesian pit viper

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• Full book reading (6 minutes!)

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• Email: Toxtalk1@gmail.com

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GOTTA PICCEM: The Poisonous Mushroom Card Game

👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

What started as a nerdy teaching tool made to teach mushroom poisoning by folks who treat mushroom poisoning is now a full-fledged card game—equally great for Friday game night and the classroom.

• 58 Poisonous Mushroom Cards
• Full-color pictures, toxin info, clinical syndromes, key anatomy, U.S. + global distribution, and spore print colors.
• 88 Play Cards + 30 Bonus Cards
• Collect mushrooms, play antidotes and modifiers, stack combos, and score big.
• Toxin-Based Scoring
• Point systems reflect real-world toxicity—every round plays differently based on your hand and bonus cards.
• Endless Replayability
• Rule variants at gottapiccem.com keep things fresh.

Dive into the companion blog at www.gottapiccem.com for:

• Deep-dive toxin explainers for each mushroom
• Case reports & real-world clinical notes
• Controversies and mysteries in mushroom poisoning

📖 Start here: gottapiccem.com (Companion Blog → “Learn the Mushrooms”)

👉 Order now right here OR go to www.gottapiccem.com and click "Buy GOTTA PICCEM"

• Multiple box options (pick your fancy)
• Ships direct from our manufacturer in South Korea
• 🌍 Global availability (shipping costs + tariffs may apply)

P.S. We’re exploring U.S. manufacturing to lower costs and expand distribution—timeline TBD—so we made the game available now.

If you grab a copy:

📸 Snap a photo of your first round

✉️ Send it to toxtalk1@gmail.com or tag @LabPoison / @tox_talk

Nothing would make Ryan happier than seeing the community play!

Listen here (https://www.wpr.org/shows/larry-meiller-show) to hear Ryan Live on AIR for the Larry Meiller show, Thursday July 17th 11:45AM-12:30 PM CST.

Check this "Listen Live" link if your having trouble!

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On August 29, 2022, twelve diners at a Markham, Ontario restaurant fell critically ill with vomiting, numbness, and life-threatening arrhythmias. The culprit? A deadly plant toxin: aconite.

In this episode—the first of a new Poison Lab Outbreak series—we go inside the Markham mass poisoning case. Join host Ryan Feldman, clinical toxicologist and emergency medicine pharmacist, as he investigates how a rare and lethal toxin ended up in a restaurant spice jar and nearly cost lives.

You’ll hear firsthand from the experts who responded to the outbreak:

• Dr. Jessica Kent, toxicology fellow at the time at the University of Toronto
• Dr. Abinhay Sathya, intensivist at Markham Stouffville Hospital
• Dr. Margaret Thompson, toxicologist and on-call consultant for the Ontario Poison Centre
• Dr. Randy Purves, research scientist at the Canadian Food Inspection Agency (CFIA)
• Bryn Shurmer, MS- analytical chemist at the Canadian Food Inspection Agency (CFIA)

Together, they walk us through the outbreak timeline—from the first patients in VT to the public health investigation that uncovered a mislabeled spice bag full of pure aconite root.

Looking for timestamps?

A fully timestamped version of the episode—so you can jump to any topic—is available to our supporting members.

💡 Key topics:

• Clinical presentation and toxic effects of aconite
• Challenges in mass poisoning recognition and coordination
• The crucial role of poison centers in outbreak response
• Public health trace-back to contaminated galangal powder
• Lessons for emergency departments and toxicologists

📍 Resources & Mentions:

• Case series about the incident written by Dr. Kent, Sathya, and Thompson
• Twitter/X post by Dr. David Juurlink that helped disseminate early info
• The Poison Lab previous aconite episode: Open and shut (Mystery Case #31)
• Paper written by Ryan, Dan McCabe, and Crissy Lawson

🎧 Listen now at: www.ThePoisonLab.com

💬 Have thoughts or questions? Connect on Instagram @tox_talk, Twitter @LabPoison, or email toxtalk1@gmail.com.

In this episode of The Poison Lab, host Ryan Feldman is joined by Dr. Amy Zosel, a medical toxicologist, emergency physician, and educator. Together, they use real poisoning cases to practice identifying toxins and flexing their toxic differential The conversation dives into intriguing and challenging toxicology cases, with a focus on educating listeners about real-world poisoning scenarios, myth-busting internet misinformation, and providing practical clinical insights.

Mini episode with Dr. Robert Bassett on Remembering Poisonous Mushrooms

Dr. Zosel and Ryan discuss:

14:15 Case 1

33:04 Case 2

• News story

37:00 Case 3

• New story

48:00 Case 4

• News story
• US outbreak

"Robocough"

Study about Naloxone in Clonidine overdose

Below this will be key takeaways regarding managing the poisonings discussed, it may ruin your experience if you are guessing the poisons

Key Takeaways:

• Amatoxin Mushroom Poisoning: The classic delayed onset of severe GI symptoms, followed by a latent phase, can mask progressive liver damage. Early recognition and treatment with hydration, silibinin, and possible liver transplant are critical.
• Tetramine Toxicity: Known for causing refractory seizures, tetramine is a rare but serious poisoning often requiring aggressive supportive care and anticonvulsants.

A Lethal mushroom hiding in edible mushrooms

Mushroom foraging danger

Resources Mentioned:

• National Poison Control Hotline: 1-800-222-1222
• National Suicide Prevention Lifeline: 1-800-273-8255
• SAMHSA Free Helpline: 1-800-662-HELP (4357)

Follow The Poison Lab:

• Twitter: @LabPoison
• Instagram: @tox_talk
• Website: www.ThePoisonLab.com

Subscribe and Review:

Love what you're hearing? Help us reach more toxicology enthusiasts by leaving a review on Apple Podcasts, Spotify, or wherever you listen. Don’t forget to share this episode with your colleagues and friends!

Review the show where ever your listening

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• Ad free episodes
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• Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

• Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

• Email: Toxtalk1@gmail.com

More Show Resources

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Review the show where ever your listening

Get Messages from Toxo (Join the Newsletter!)

Join as a supporting member

• Ad free episodes
• Bonus content and early access
• Discounts and give aways on GOTA PICCEM Mushroom card game

The GOTTA PICCEM Poisonous Mushroom Game!

The Poisonus Fungus Amongus Children's Book!

• Full book reading (6 minutes!)

Tox trinkets (Rep the show at home!)

• Email: Toxtalk1@gmail.com

More Show Resources

• Ryan's Medical Games and Resources
• Show Website

If you are looking for links to Dr. Basset's initiatives check back later, they are not fully launched yet!

Check it out on Dr. Hamilton's website as well

Poison Mushrooms! Got’a Pic’em (GOTAAPPICEM) A mnemonic device to sort through mushroom ingestions – The Hot Stove League of EM/Tox

The GOTAA PPICCEM Mnemonic

These mushrooms have delayed symptoms (>6 hours) and are associated with significant toxicity:

G – Gyromitrin (Gyromitra esculenta) – False morels; inhibits GABA, leading to seizures.

O – Orellanine (Cortinarius spp.) – Causes renal failure; famously poisoned The Horse Whisperer author.

T – Tricholoma equestre (Man on Horseback) – Leads to rhabdomyolysis.

A – Amatoxin (Amanita phalloides, Galerina spp.) – Causes liver failure; the most lethal mushroom toxicity.

A² – Allenic norleucine (Amanita smithiana) – Found in the Pacific Northwest; early GI symptoms followed by renal failure.

These may present early but still cause significant toxicity.

P² – Paxillus spp. – Can cause hemolytic anemia and multi-organ injury.

P– Psilocybin (Psilocybe spp.) – Hallucinogenic, similar to LSD, typically low toxicity but may cause hyperthermia or seizures.

Symptoms appear within 6 hours and are usually self-limited.

I – Ibotenic Acid & Muscimol (Amanita muscaria, Amanita pantherina) – Acts like a “mushroom speedball”, causing both stimulant and sedative effects.

C – Coprine (Coprinus spp., Inky Caps) – Induces disulfiram-like reaction with alcohol.

E –  Emetic Mushrooms (LBMs: Little Brown Mushrooms) – Various species that cause self-limited vomiting and diarrhea.

M – Muscarine (Clitocybe, Inocybe spp.) – Cholinergic crisis (SLUDGE symptoms), similar to nerve agents.

Ryan's Modified Mnemonic GOTTAAA PICCEM

The GOTTA3  P2ICCEM Mnemonic (Ryan's Modification)

These mushrooms have delayed symptoms (>6 hours) and are associated with significant toxicity:

G – Gyromitrin (Gyromitra esculenta) – False morels; inhibits GABA, leading to seizures. While this is classically taught, newer data suggests its extremely rare, GI effects, with or without hepatoxicity or minor neurologic symptoms predominate

O – Orellanine (Cortinarius spp.) – Causes renal failure; famously poisoned The Horse Whisperer author.

T – Tricholoma equestre (Man on Horseback) – Leads to rhabdomyolysis.

T- Tender nesting polypore (Hapalopilus rutilans) causes late GI effects,  altered mental status, acidosis, and purple urine!

A – Amatoxin (Amanita phalloides, Galerina spp.) – Causes liver failure; the most lethal mushroom toxicity.

A- Acromelic Acid is found in Clitocybe acromelalga in Japan and C amoenolens in France causes erythromelalgia. It can be treated with IV nicotinic acid!

A² – Allenic norleucine (Amanita smithiana) – Found in the Pacific Northwest; early GI symptoms followed by renal failure.

These may present early but still cause significant toxicity.

P² – Paxillus spp. – Can cause hemolytic anemia and multi-organ injury.

P– Psilocybin (Psilocybe spp.) – Hallucinogenic, similar to LSD, typically low toxicity but may cause hyperthermia or seizures.

Symptoms appear within 6 hours and are usually self-limited.

I – Ibotenic Acid & Muscimol (Amanita muscaria, Amanita pantherina) – Acts like a “mushroom speedball”, causing both stimulant and sedative effects.

C – Coprine (Coprinus spp., Inky Caps) – Induces disulfiram-like reaction with alcohol. Thee are actually many species that have been implciated here incuding Verpa bohemica (early morel) and Boletus luridus (luride bolete).

C- Cholinergics (muscarine containing, Clitocybe, Inocybe spp.) Cholinergic crisis (SLUDGE symptoms), similar to nerve agents.

E –  Emetic Mushrooms (LBMs: Little Brown Mushrooms) – Various species that cause self-limited vomiting and diarrhea.

M – Morchella (morels) while an edible delicacy, they must be thoroughly cooked, recently multiple deaths have been links to eating morels, and the exact mechanism of toxicity is unclear but they result in incredibly fast GI effects.