Jimson weed: Difference between revisions
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==Differential Diagnosis== | ==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 types}} | {{Anticholinergic types}} | ||
Revision as of 15:33, 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
Anticholinergic toxicity Causes
- Medications[3]
- Atropine
- Antihistamines
- Antidepressants
- Antipsychotics
- Muscle relaxants
- Anti-Parkinsonians
- Plants
- Jimson weed (Devil's trumpet)
- Amanita mushroom
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
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.