TOXICOLOGY & ADDICTION MEDICINE
From Jet Fuel to Mushrooms: Recognizing GABA Antagonist Toxicity in the Emergency Department By Kelsey Billups, PharmD and Tiana Patriarca, PharmD, on behalf of the SAEM Academy of Emergency Medicine Pharmacists Toxicology Writing Group
SAEM PULSE | MAY-JUNE 2026
At a Glance
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• Why this matters now: Uncommon toxins such as hydrazines, isoniazid and Gyromitra mushrooms can cause rapid, life-threatening seizures through disruption of gamma-aminobutyric acid pathways, requiring immediate recognition and treatment. • What you’ll learn: A clinically focused overview of mechanisms, exposure sources and high-yield management strategies, including
antidote use with pyridoxine and seizure control in gammaaminobutyric acid antagonist toxicity. • Who this is for: Emergency physicians, pharmacists, residents and toxicology clinicians managing acute seizures and undifferentiated neurotoxicity in the emergency department. Gamma-aminobutyric acid (GABA) is the primary inhibitory
neurotransmitter of the central nervous system, acting at GABA receptors to balance excitatory glutamate neurotransmission and maintain normal cognition and behavior. GABA antagonists inhibit chloride-driven hyperpolarization at GABA-A receptors, leading to neuroexcitation and decreased inhibitory tone. Profound agitation, refractory seizures, and death may result. Because toxicity from these