INTOXICATION AFTER INGESTION OF A DELETERIOUS PLANT

4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki

Medical School of Aristotle University

Soulaidopoulos S., Ligdi L., Sinakos E.

Case descriptionAn elderly couple (m: 86 f:82) were brought to the ER for acute onset of:

• Discount consciousness• Hallucinations

• Excitation• Delirium

History: Consumption of the foliage of the toxic plant among with other greens

Medical history m : AF, Coronary Artery Disease

f : Hypertension

Clinical condition :

Both of them disoriented, agitated, making purposeless movements

with irrepressible speech and hallucinations

pupils: dilated not responding to light

Abdomen: urinary retention, lessening intestinal peristalsis

Treatment• Communication with the poison centre for instructions

Supportive treatment

- gastric decontamination with nasogastric lavage

- administration of activated charcoal via a gastric tube

- Benzodiazepines were administered to control the agitation and hallucinations

(diazepam iv 5mg x 2 daily)

• Both of the patient stayed under monitoring for the first 24 hours.• There was a gradual improvement at their level of conscousness.• They were discharged home after four days of hospitalization

Physostigmine

- reversible acetylcholinesterase inhibitor capable of directly antagonizing

CNS manifestations of anticholinergic toxicity

- side effects : salivation, lacrimation, urination, defecation, emesis, life-threatening cholinergic crisis

( asystole, respiratory depression, seizures)

Causes of disorders of consciousness• Traumatic brain injury (falls, traffic accidents, violent assaults)

• Non- traumatic brain injury

- strokes

- heart attack

- systemic and brain infections (meningitis, encephalitis)

- drug overdoses

- poisoning

- types of suffocation (almost drowning, smoke inhalation)

- cerebral hemorrhage (ruptured aneurysm)

- epilepsy

- metabolic disorders

- vertigo

• Progressive brain damage ( Parkinson’s & Alzheimer’s disease, brain tumors)

• Psychiatric condition (conversion disorder)

Datura Stramonium

• Member of the Solanaceae family• Jimson weed, Devil's snare•  herbal medicine for asthma symptoms• powerful hallucinogen and deliriant• dangerous levels of the tropane alkaloids atropine, hyoscyamine and scopolamine

• Datura intoxication

- typically produces delirium, hyperthermia, tachycardia, bizarre behavior

- severe mydriasis with resultant painful photophobiaronounced 

- amnesia  

- onset of symptoms around 30 to 60 minutes after ingesting the herb

- the symptoms last from 24 to 48 hours

Take home messages

• Always consider poisoning when there are same clinical manifestation from the CNS at people living together

• Datura Stramonium intoxication should be considered in cases of patients presenting with unexplained peripheral and central anticholinergic symptoms including delirium, agitation and seizures