Jimson weed

Background

Datura stramonium aka Jimson Weed
  • Contains up to 28 different anticholinergic alkaloids[1]
  • 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

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

Evaluation

Clinical diagnosis with history and physical exam

  • Dry as a bone: anhidrosis (esp axillae, mouth)
  • Hot as a hare: anhydrotic hyperthermia (may become severe w/ agitation)
  • 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
  • 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

  1. Krenzelok EP. Aspects of Datura poisoning and treatment. Clin Tox. 2010; 48(2):104-110.
  2. Shervette RE, et al. Jimson "loco" weed abuse in adolescents. Pediatrics. 1979; 63:520-523.