Finally, based on outward appearance, real morels are rather uniformly shaped and covered in pits that seem to fall inwards, whereas false morels are often considered more irregularly shaped with wavy ridges that seem to form outwards. The symptoms of poisoning are typically gastrointestinal and neurological. Symptoms occur within 6–12 hours of consumption, although cases of more severe poisoning may present sooner—as little as 2 hours after ingestion. Initial symptoms are gastrointestinal, with sudden onset of nausea, vomiting, and watery diarrhea which may be bloodstained. Dehydration may develop if the vomiting or diarrhea is severe. Dizziness, lethargy, vertigo, tremor, ataxia, nystagmus, and headaches develop soon after; fever often occurs, a distinctive feature which does not develop after poisoning by other types of mushrooms. In most cases of poisoning, symptoms do not progress from these initial symptoms, and patients recover after 2–6 days of illness. In some cases there may be an asymptomatic phase following the initial symptoms which is then followed by more significant toxicity including kidney damage, liver damage, and neurological dysfunction including seizures and coma. These signs usually develop within 1–3 days in serious cases. The patient develops jaundice and the liver and spleen become enlarged, in some cases blood sugar levels will rise (hyperglycemia) and then fall (hypoglycemia) and liver toxicity is seen. Additionally, intravascular hemolysis causes destruction of red blood cells resulting in increases in free hemoglobin and hemoglobinuria, which can lead to kidney toxicity or kidney failure. Methemoglobinemia may also occur in some cases. This is where higher than normal levels of methemoglobin—a form of hemoglobin that can not carry oxygen—are found in the blood. It causes the patient to become short of breath and cyanotic. Cases of severe poisoning may progress to a terminal neurological phase, with delirium, muscle fasciculations and seizures, and mydriasis progressing to coma, circulatory collapse, and respiratory arrest. Death may occur from five to seven days after consumption. Toxic effects from gyromitrin may also be accumulated from sub-acute and chronic exposure due to "professional handling"; symptoms include pharyngitis, bronchitis, and keratitis. Treatment is mainly supportive; gastric decontamination with activated charcoal may be beneficial if medical attention is sought within a few hours of consumption. However, symptoms often take longer than this to develop, and patients do not usually present for treatment until many hours after ingestion, thus limiting its effectiveness.