Jimson weed

Datura stramonium aka Jimson Weed

Background

• Contains up to 28 different anticholinergic alkaloids
  • 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

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

1. Sympathomimetic toxicity
   • Red, dry skin and absent bowel sounds favors anticholinergic toxicity
2. Encephalitis
3. Head trauma
4. ETOH/sedative withdrawal
5. Neuroleptic Malignant Syndrome (NMS)
6. Acute psychotic disorder

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

See Also

• Anticholinergic toxicity
• Toxicology (Main)