CASO
Anamnesi | Un ragazzo di 12 anni sta giocando a calcetto con gli amici in una zona limitrofa al parco in cui abita. Dopo circa 30 minuti il ragazzo si accascia a terra. Il ragazzo è portato di corsa al pronto soccorso ove si presenta diaforetico, bradicardico, ipoteso, broncospastico, scialorretico e ha convulsioni. I medici iniziano a fare una serie di accertamenti perché il caso è molto suggestivo. Dopo qualche giorno di ricovero il ragazzo torna a casa. Cosa può essere successo ?
SOLUZIONE
Diagnosi | Intossicazione da Muscarina (Amanita Muscaria)
L’ Amanita muscaria è un fungo velenoso noto per essere quello da cui fu estratta inizialmente la muscarina. La muscarina è un farmaco parasimpatico mimetico che determina attivazione diretta dei recettori muscarini dell’acetilcolina. Esistono 5 recettori muscarinici, tutti metabotropici associati a proteine G (GPCR) e con localizzazione preferenziale ma non esclusiva. I recettori M1 sono anche detti nervosi, quelli M2 anche detti cardiaci, quelli M3 sono prevalentemente disseminati lungo il tratto gastrointestinale e sulla vescica dove regolano la motilità e la secrezione ghiandolare, quelli M4 sono distribuiti sui grossi bronchi ove inducono broncocostrizione e stimolano la secrezione mucosale e quelli M5 dal significato ignoto. L’attivazione di questa popolazione recettoriale da parte della muscarina è aspecifica cioè essa attiva indistintamente tutti questi recettori. Pertanto l’ingestione di grosse quantità di muscarina provoca una sindrome da iperattivazione parasimpatica legata all’attivazione multiorgano di tutti i recettori e quindi di tutte le loro risposte fisiologiche a valle (miosi e accomodazione, bradicardia, broncospasmo, sudorazione profusa, ipersalivazione, convulsioni etc.). In caso di pericolo di vita la muscarina è antagonizzata usando parasimpatico litici come l’ ATROPINA che è il farmaco antimuscarinico più usato in queste condizioni di emergenza. Qual è stata dunque la dinamica dell’incidente ? Probabilmente il ragazzo ha ingerito dell’Amanita muscaria trovata sul campetto di calcio ove giocava, incosciente delle conseguenze del gesto e del pericolo che corre. Per queste complicanze severe è raccomandato a tutti coloro che per diletto vanno alla ricerca di funghi di evitare funghi particolarmente colorati (soprattutto quelli rossi) perché è molto probabile siano funghi velenosi contenenti tossici sia attivi sul parasimpatico che su altre funzioni vitali (frequentemente sono epatotossici e possono causa necrosi panlobulare del fegato con epatite fulminante)
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