Jimson weed: Difference between revisions
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==Background== | ==Background== | ||
*Contains anticholinergic alkaloids | *Contains up to 28 different anticholinergic alkaloids<ref>Krenzelok EP. Aspects of Datura poisoning and treatment. Clin Tox. 2010; 48(2):104-110.</ref> | ||
**Atropine, hyoscyamine, and scopolamine | **Atropine, hyoscyamine, and scopolamine | ||
*50-100 seeds in each pod | *All parts of the plant are toxic but the highest concentration is in the seeds | ||
*100 seeds is the equivalent of about 6 mg atropine | **50-100 seeds in each pod | ||
**100 seeds is the equivalent of about 6 mg atropine | |||
*Estimated lethal doses of atropine in adults ≥10 mg<ref>Shervette RE, et al. Jimson "loco" weed abuse in adolescents. Pediatrics. 1979; 63:520-523.</ref> | |||
==Administration== | ==Administration== | ||
*Inhalation | *Inhalation (smoking dried leaves or other plant parts) | ||
*Ingestion (eating plant parts or foods containing extracts) | |||
*Ingestion | |||
==Diagnosis== | ==Diagnosis== | ||
*History of plant ingestion/smoking | *History of plant ingestion/smoking | ||
*Anticholinergic toxidrome | *[[Anticholinergic toxicity|Anticholinergic toxidrome]] | ||
*Symptoms can last for days if seeds were ingested | *Symptoms can last for days if seeds were ingested | ||
== | ==Differential Diagnosis== | ||
[[ | #Sympathomimetic toxicity | ||
#*Red, dry skin and absent bowel sounds favors anticholinergic toxicity | |||
#Encephalitis | |||
#Head trauma | |||
#ETOH/sedative withdrawal | |||
#[[Neuroleptic Malignant Syndrome (NMS)]] | |||
#Acute psychotic disorder | |||
==Differential | ===Toxidrome Differential Chart=== | ||
{{Template:Toxidrome Chart}} | |||
==Treatment== | ==Treatment== | ||
*Supportive care and patient reassurance | |||
*Sedation as needed with benzos | |||
*In severe cases, physostigmine 0.5–2.0 mg IV at a rate of no more than 1 mg/min (adult dosing) | |||
**A second dose may be administered if necessary | |||
**Children should receive 0.02 mg/kg intravenously and the rate should not exceed 0.5 mg/min | |||
==See Also== | ==See Also== | ||
[[Anticholinergic toxicity]] | *[[Anticholinergic toxicity]] | ||
*[[Toxicology (Main)]] | |||
==Source== | ==Source== | ||
<references/> | |||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 15:40, 19 April 2015
Background
- Contains up to 28 different anticholinergic alkaloids[1]
- Atropine, hyoscyamine, and scopolamine
- All parts of the plant are toxic but the highest concentration is in the seeds
- 50-100 seeds in each pod
- 100 seeds is the equivalent of about 6 mg atropine
- Estimated lethal doses of atropine in adults ≥10 mg[2]
Administration
- Inhalation (smoking dried leaves or other plant parts)
- Ingestion (eating plant parts or foods containing extracts)
Diagnosis
- History of plant ingestion/smoking
- Anticholinergic toxidrome
- Symptoms can last for days if seeds were ingested
Differential Diagnosis
- Sympathomimetic toxicity
- Red, dry skin and absent bowel sounds favors anticholinergic toxicity
- Encephalitis
- Head trauma
- ETOH/sedative withdrawal
- Neuroleptic Malignant Syndrome (NMS)
- Acute psychotic disorder
Toxidrome Differential Chart
Toxidrome Chart
| Finding | Cholinergic | Anticholinergic | Sympathomimetic | Sympatholytic^ | Sedative/Hypnotic |
| Example | Organophosphates | TCAs | Cocaine | Clonidine | ETOH |
| Temp | Nl | Nl / ↑ | Nl / ↑ | Nl / ↓ | Nl / ↓ |
| RR | Variable | Nl / ↓ | Variable | Nl / ↓ | Nl / ↓ |
| HR | Variable | ↑ | ↑ (sig) | Nl / ↓ | Nl / ↓ |
| BP | ↑ | ↑ | ↑ | Nl / ↓ | Nl / ↓ |
| LOC | Nl / Lethargic | Nl, agitated, psychotic, comatose | Nl, agitated, psychotic | Nl, Lethargic, or Comatose | Nl, Lethargic, or Comatose |
| Pupils | Variable | Mydriatic | Mydriatic | Nl / Miotic | |
| Motor | Fasciculations, Flacid Paralysis | Nl | Nl / Agitated | Nl | |
| Skin | Sweating (sig) | Hot, dry | Sweating | Dry | |
| Lungs | Bronchospasm / rhinorrhea | Nl | Nl | Nl | |
| Bowel Sounds | Hyperactive (SLUDGE) | ↓ / Absent | Nl / ↓ | Nl / ↓ |
- ^Consider Sympatholytic when looking at Sedative OD or someone who doesn't respond to Narcan
- Withdrawal from substances have the opposite effect
Treatment
- Supportive care and patient reassurance
- Sedation as needed with benzos
- In severe cases, physostigmine 0.5–2.0 mg IV at a rate of no more than 1 mg/min (adult dosing)
- A second dose may be administered if necessary
- Children should receive 0.02 mg/kg intravenously and the rate should not exceed 0.5 mg/min