Jimson weed: Difference between revisions
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==Background== | |||
[[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 | ||
| Line 10: | Line 8: | ||
*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> | *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 (smoking dried leaves or other plant parts) | *Inhalation (smoking dried leaves or other plant parts) | ||
*Ingestion (eating plant parts or foods containing extracts) | *Ingestion (eating plant parts or foods containing extracts) | ||
== | ==Clinical Features== | ||
*History of plant ingestion/smoking | *History of plant ingestion/smoking | ||
*[[Anticholinergic toxicity|Anticholinergic toxidrome]] | *[[Anticholinergic toxicity|Anticholinergic toxidrome]] | ||
| Line 30: | Line 28: | ||
===Toxidrome Differential Chart=== | ===Toxidrome Differential Chart=== | ||
{{Template:Toxidrome Chart}} | {{Template:Toxidrome Chart}} | ||
==Diagnosis== | |||
==Treatment== | ==Treatment== | ||
| Line 42: | Line 42: | ||
*[[Toxicology (Main)]] | *[[Toxicology (Main)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 15:31, 17 September 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)
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
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
Diagnosis
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