Jimson weed: Difference between revisions
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[[File:Jimson_weed.png|thumb|Datura stramonium aka Jimson Weed]] | [[File:Jimson_weed.png|thumb|Datura stramonium aka Jimson Weed]] | ||
*Contains up to 28 different anticholinergic alkaloids<ref>Krenzelok EP. Aspects of Datura poisoning and treatment. Clin Tox. 2010; 48(2):104-110.</ref> | *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]] | ||
*All parts of the plant are toxic but the highest concentration is in the seeds | *All parts of the plant are toxic but the highest concentration is in the seeds | ||
**50-100 seeds in each pod | **50-100 seeds in each pod | ||
| Line 28: | Line 28: | ||
{{Anticholinergic types}} | {{Anticholinergic types}} | ||
== | ==Evaluation== | ||
Clinical diagnosis with history and physical exam | Clinical diagnosis with history and physical exam | ||
{{Clinical Features Anticholinergic Toxicity}} | {{Clinical Features Anticholinergic Toxicity}} | ||
| Line 35: | Line 35: | ||
*Supportive care and patient reassurance | *Supportive care and patient reassurance | ||
*Sedation as needed with benzos | *Sedation as needed with benzos | ||
*In severe cases, physostigmine 0.5–2. | *In severe cases, [[physostigmine]] 0.5–2.0 mg IV at a rate of no more than 1mg/min (adult dosing) | ||
**A second dose may be administered if necessary | **A second dose may be administered if necessary | ||
**Children should receive 0. | **Children should receive 0.02 mg/kg intravenously and the rate should not exceed 0.5 mg/min | ||
**Note that [[pyridostigmine]] does not cross the blood brain barrier, and is a poor agent for agitation, CNS features | |||
==See Also== | ==See Also== | ||
Revision as of 02:43, 27 January 2019
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 6mg atropine
- Estimated lethal doses of atropine in adults ≥10mg[2]
Administration
- Inhalation (smoking dried leaves or other plant parts)
- Ingestion (eating plant parts or foods containing extracts)
Clinical Features
- 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
Anticholinergic toxicity Causes
- Medications[3]
- Atropine
- Antihistamines
- Antidepressants
- Antipsychotics
- Muscle relaxants
- Anti-Parkinsonians
- Plants
- Jimson weed (Devil's trumpet)
- Amanita mushroom
Evaluation
Clinical diagnosis with history and physical exam
- Red as a beet: cutaneous vasodilation
- Blind as a bat: nonreactive mydriasis (often delayed 12-24hr)
- Mad as a hatter: delirium; attention deficit; hallucinations; dysarthria; lethargy
- Full as a flask: urinary retention
- Hot as a hare: anhydrotic hyperthermia (may become severe w/ agitation)
- Dry as a bone: anhidrosis (esp axillae, mouth)
- And the heart runs alone: Tachycardia (HR 120-160) and decreased/absent bowel sounds
Management
- 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 1mg/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
- Note that pyridostigmine does not cross the blood brain barrier, and is a poor agent for agitation, CNS features
See Also
References
- ↑ Krenzelok EP. Aspects of Datura poisoning and treatment. Clin Tox. 2010; 48(2):104-110.
- ↑ Shervette RE, et al. Jimson "loco" weed abuse in adolescents. Pediatrics. 1979; 63:520-523.
- ↑ Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium – theory, evidence and practice. Br J Clin Pharmacol. 2015;81(3):516-24.