A 39-year-old Thai woman, living in the Netherlands, was seen at the emergency department with symptoms of nausea and vomiting for a few hours. She had no relevant medical history and was not taking any medications. She looked moderately ill, had a blood pressure of 91/53 mmHg and a regular pulse of 103 beats/min, with no fever. On admission, her blood tests showed a metabolic acidosis, most likely caused by enteral bicarbonate loss (table 1). Supportive care was started. The patient told us that one day prior to her presentation, she had eaten a homemade soup with mushrooms picked from a local forest. We performed a bedside test on such mushroom, by letting juice from the cap dry on a piece of newspaper and subsequently adding concentrated hydrochloric acid (25% HCl). After several minutes the stain changed colour from yellowish to pale blue, indicating a positive test. The test set-up and result are shown in figure 1.
WHAT TYPE OF MUSHROOM DID OUR PATIENT INGEST AND WHAT IS THE NAME OF THE BEDSIDE TEST ?