Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Toxic Effects, Mushrooms


Related Terms

  • Mushroom Poisoning
  • Toadstool Poisoning

Differential Diagnosis

Specialists

  • Emergency Medicine Physician
  • Medical Toxicologist
  • Pharmacologist
  • Preventive Medicine Specialist

Comorbid Conditions

  • Hepatic disease
  • Renal disease

Factors Influencing Duration

The levels, duration, and route of exposure; the immediacy of treatment; and the individual's response to exposure and treatment determine length of disability. Age, health, and physical condition all influence how an individual responds to exposure to mushroom poisoning and the ensuing treatment. Long-term effects may result when persons in ill health and the elderly are involved.

Medical Codes

ICD-9-CM:
988.1 - Toxic Effects, Mushrooms

Overview

Mushroom poisoning is a toxic, sometimes fatal, result of eating raw or cooked poisonous mushrooms. The toxins involved in mushroom poisoning are produced naturally by the fungi themselves. The mushrooms that most commonly cause poisoning are Amanita muscaria, A. phalloides (the death cap), and four white Amanita species called destroying angels.

Old wives' tales notwithstanding, there is no general rule for distinguishing edible mushrooms from poisonous mushrooms. Most mushrooms that cause human poisoning cannot be made nontoxic by cooking, canning, freezing, or any other means of processing. The only way to avoid poisoning is to avoid consumption of the toxic species.

Seventy to eighty species of mushrooms are poisonous to humans. Many of them contain toxic alkaloids (muscarine, agaricin, and phallin). Mushroom poisonings are generally acute and are manifested by a variety of symptoms and prognoses, depending on the amount and species consumed. Because the chemistry of many of the mushroom toxins, especially the less deadly ones, is still unknown and positive identification of the mushroom eaten is often impossible, mushroom poisonings are categorized by their physiological effects.

There are seven categories of mushroom toxins: amatoxins, orellanus, gyromitrin, muscarine, ibotenic acid, psilocybin, and coprine or disulfiram-like. Ninety-five percent of all mushroom fatalities in North America are associated with Amanita species mushrooms (Cataletto). Mortality rates have dropped in recent years because of improved treatment options, including hemodialysis, but still range from 10% to 50% (Chang; Habal; Kaminstein).

Amanita poisoning can be divided into three stages. The first stage is a latent period of 6 to 12 hours, followed by abdominal cramping, vomiting, and profuse watery diarrhea. In the second stage, the individual appears to be improved, but there is ongoing liver damage that is indicated by elevated laboratory values. The third stage may progress to sudden liver failure with kidney damage. If death does not occur, recovery takes at least 2 to 3 weeks.

Poisonings in the US occur most commonly when foragers for wild mushrooms misidentify and consume a toxic species. Often recent immigrants will collect and eat a poisonous US species that closely resembles an edible wild mushroom from their native land. Other poisonings occur when mushrooms that contain psychoactive compounds are intentionally consumed by persons who desire these effects.

Incidence and Prevalence: In 2003, there were 8,722 mushroom exposure incidents in US reported by the American Association of Poison Control Centers, with 5 deaths and 45 serious outcomes. More than 80% of mushrooms causing toxic effects remained unidentified. General estimates put the incidence of toxic mushroom exposure in the US at 5 per 100,000 population per year (Watson).

Source: Medical Disability Advisor



Causation and Known Risk Factors

There is no predisposition to mushroom poisoning based on age, sex, or race. The only risk factor is consuming poisonous mushrooms. However, children under age 6 account for over half the reported poisonings (Watson).

Source: Medical Disability Advisor



Diagnosis

History: Almost all toxic mushrooms give rise to violent gastrointestinal symptoms, such as vomiting, abdominal cramps, and diarrhea after a period of 30 to 180 minutes after eating the toxin, although these symptoms may be delayed for 6 to 12 hours in Amanita poisoning. Gastrointestinal distress is usually the first symptom the individual notices. Other symptoms vary with the species eaten, but common symptoms include watering eyes (lacrimation), excessive salivation, profuse sweating, abnormal contraction or dilation of the pupils, blurred vision, dizziness, confusion, coma, convulsions, difficulty breathing, and rapid heartbeat.

Physical exam: An exam may reveal rapid heartbeat (tachycardia), low blood pressure (hypotension), and respiratory distress. Depending on the time elapsed after ingestion, there may be signs of liver, kidney, and central nervous system involvement. Examination may reveal jaundice, bruising (may be present with hepatic failure), and mild abdominal tenderness. There may be bloody diarrhea. Urine output may be substantially decreased, and signs of dehydration may be present. Nervous system abnormalities range from confusion and lethargy to coma.

Tests: CBC, urinalysis, coagulation studies, glucose, BUN, creatinine, electrolytes, fibrinogen, and arterial blood gases are all helpful, both in making a diagnosis and in evaluating the degree of organ damage. Prothrombin time (PT) is most reliable indicator for severity of poisoning. The level of electrolytes, BUN, and creatinine indicates dehydration from vomiting and diarrhea. Glucose levels may be monitored very closely for liver (hepatic) failure. Blood and/or protein in the urine indicates kidney (renal) involvement. The presence of amylase/lipase (enzymes) indicates an inflammation of the pancreas (pancreatitis).

If a specimen of the mushroom ingested is available for analysis, a Meixner test may be used to determine the presence of amatoxins. This test cannot be done on stomach contents, however, because of the risk of false readings.

Source: Medical Disability Advisor



Treatment

Initial steps in treating suspected mushroom poisoning involve ridding the body of as much toxin as possible. Vomiting should be induced immediately. Stomach pumping (gastric lavage) is used to remove the remaining stomach contents. Activated charcoal may be given in repeated doses. In the case of Amanita poisoning, hemodialysis or filtering impurities from the blood (hemoperfusion) and a forced increase in urine output (diuresis) all help rid the body of toxins. Keeping the individual hydrated is also a priority. Early rehydration contributes to improved survival rates. Once as much of the toxin as possible is removed, continuing care is supportive.

Source: Medical Disability Advisor



Prognosis

The normal course of mushroom poisoning varies with the amount and type of mushroom eaten and the age and health of the individual and is as follows: about half the population experience no symptoms; one-quarter of those exposed require treatment in a health care facility; minor symptoms occur in 10% to 15% of individuals, while 5% have moderate symptoms; about 0.2% experience major toxicity; the overall mortality rate is estimated at 0.016% (Cataletto). Severe liver and kidney damage can occur from some types of mushroom poisonings, even when individuals survive. A liver transplant may be a life-saving necessity for the most severe cases of amatoxin poisoning. Complete recovery from poisoning by many of the less toxic mushrooms can be expected.

Source: Medical Disability Advisor



Rehabilitation

For individuals affected by the toxic effects of mushrooms, the rehabilitation program varies. The intensity and progression of exercises depend on the affected body organs, specifically the respiratory system and kidneys, and the individual's overall health.

Rehabilitation for individuals experiencing a toxic condition from the effects of mushrooms depends on how the body reacts to this disorder. Once initial symptoms (including abdominal cramps, high fever, headache, and diarrhea) have subsided and a physician determines no contraindications for physical activity, the rehabilitation professional initiates a gradual strengthening program, using general strengthening and aerobic-type activities. These activities focus on increasing the individual's ability to work and resistance to fatigue.

In more severe cases, the therapist may instruct the individual with breathing difficulties in respiratory exercises to improve ventilation. In time, the individual begins to perform strengthening exercises to help muscle weakness and is instructed in the importance of remaining active. When resistance is tolerated, the individual may proceed to isotonic exercise using an elastic band or light weights that provide resistance.

Balance exercises, such as side stepping and walking with the eyes closed with and without assistance, help in addressing any loss of balance and coordination that this condition may have created. Following a liver transplant and impaired kidney function, occupational therapy may be needed before an individual returns to work.

Source: Medical Disability Advisor



Complications

Liver failure is the most serious complication of amatoxin ingestion. Liver (hepatic) coma and hypoglycemia can complicate liver failure. Progressive hepatic failure can lead to functional kidney failure (hepatonephric syndrome).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals may experience a period of prolonged fatigue following mushroom poisoning and may temporarily need to be reassigned to less strenuous work. Prevention of mushroom poisoning rests upon educating individuals to avoid eating any wild mushrooms not positively identified as edible by a competent authority.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has individual recently eaten wild mushrooms? If so, what did they look like, and when were they ingested?
  • Does individual report watering eyes (lacrimation), contraction of the pupils (miosis), salivation, sweating, vomiting, abdominal cramps, or diarrhea?
  • Has individual experienced a spinning sensation (vertigo), confusion, or convulsions?
  • Were electrolyte levels, blood urea nitrogen (BUN), and creatinine done to determine whether dehydration or kidney damage occurred?
  • Was a specimen of mushroom available for analysis?

Regarding treatment:

  • Was vomiting induced immediately?
  • Did individual require pumping of the stomach (gastric lavage) or activated charcoal?
  • Did individual require rehydration with an intravenous electrolyte solution?
  • Did individual require intensive supportive care for liver (hepatic) or kidney (renal) failure?
  • Were symptoms completely resolved with treatment?

Regarding prognosis:

  • Did individual receive prompt and appropriate treatment?
  • Are there special attributes of the particular individual that make it more or less likely that he or she would be so affected?
  • Has individual developed liver and/or kidney failure?
  • Is this individual a candidate for liver transplantation?
  • What is the expected outcome for this individual with treatment for complications?

Source: Medical Disability Advisor



References

Cited

Cataletto, Mary E. "Toxicity, Mushrooms." eMedicine. Eds. David A. Peak, et al. 5 Aug. 2004. Medscape. 4 Jan. 2005 <http//emedicine.com/emerg/topic874.htm>.

Chang, A. K. "Toxicity, Mushroom - Amatoxin." eMedicine. Eds. Jeffrey Glenn Bowman, et al. 2 Aug. 2004. Medscape. 4 Jan. 2005 <http://emedicine.com/emerg/topic818.htm>.

Habal, Rania, and Jorge A. Martinez. "Toxicity, Mushroom." eMedicine. Eds. Laurie Robin Grier, et al. 2 Aug. 2004. Medscape. 4 Jan. 2005 <http://emedicine.com/med/topic1527.htm>.

Kaminstein, David, ed. "Mushroom Poisoning." Gale Encyclopedia of Medicine. 2nd ed. Farmington Hills, MI: Gale Group, 2001.

Watson, William A., et al. "2002 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System." American Journal of Emergency Medicine 21 5 (2003): 353-421.

Source: Medical Disability Advisor






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