This stage may last as long as 2-3 days. Hepatic and renal injury become clinically apparent and may progress to fulminant hepatic failure in the third phase. Death may occur in 3-7 days. Eighty-eight percent of reported mushroom exposures were unidentified. One author estimates incidence of mushroom exposures at 5 exposures per 100,000 population per year.
Mushroom foraging is more common in parts of Europe and Russia than in other parts of the world.
Worldwide, most mushroom fatalities are ascribed to amatoxins. Mortality is higher in children because they absorb a larger dose of toxins per body weight. With amatoxin ingestion, onset of GI symptoms typically is delayed 6-12 hours or more. An earlier onset of symptoms suggests that another mushroom is responsible for symptomatology. If the patient's meal included several different mushrooms, however, an earlier onset of symptomatology does not rule out concomitant amatoxin ingestion.