Intoxicación por Datura stramonium: serie de tres casos / Datura stramonium poisoning: series of three cases

Se presenta una serie de tres casos de pacientes menores de edad con intoxicación por ingesta de semillas de Datura stramonium, ocurridos durante el mes de mayo en la provincia de Mendoza. Pacientes de sexo masculino, ente 15 y 3 años de edad. Uno de ellos asociado con ingesta intencional de semillas y otros dos por intoxicación accidental al ingerir las semillas jugando con el fruto de la planta. La recolección de semillas se realizó en zona rural periurbana, y todos los casos fueron llevados a la consulta por familiares directos, ante la presencia de desorientación, ataxia y disartria. Los tres pacientes desarrollaron síndrome anticolinérgico, con delirio y alucinaciones, requiriendo internación y tratamiento sintomático, con buena evolución y recuperación completa entre las 24 y 72 horas. Se resalta el riesgo que representa la presencia de este vegetal tóxico, no sólo por su fácil disponibilidad, sino por las bajas dosis letales de sus alcaloides y la falta de diagnóstico etiológico por parte de los servicios de urgencia.

A series of three cases of pediatric patients with poisoning by ingestion of seeds of Datura stramonium, which occurred during the month of May in the province of Mendoza is presented. Male patients, among 15 and 3 years old. One associated with intentional ingestion of seeds and other two by accidentally ingesting seeds while playing with the fruit of the poisonous plant. Seed collection was conducted in rural and peri-urban areas, and all patients were brought to the office by relatives, due to the presence of dysarthria disorientation and ataxia. The three patients developed anticholinergic syndrome with delirium and hallucinations, requiring hospitalization and symptomatic treatment. All cases had favorable outcome and complete recovery within 24 to 72 hours. It is highlighted the risk posed by the presence of this toxic plant, not only for its easy availability, but low lethal doses of its alkaloids and lack of etiological diagnosis by emergency services.

Risk assessment of buckwheat flour contaminated by thorn-apple (Datura stramonium L.) alkaloids: a case study from Slovenia.

In Slovenia, a mass poisoning incident involving 73 consumers with symptoms such as dry mouth, hot red skin, blurred vision, tachycardia, urinary retention, ataxia, speech disturbance, disorientation and visual hallucinations occurred in 2003. In all cases, consumers had eaten buckwheat flour food products within the last few hours. Investigations by responsible authorities identified the contamination of a range of buckwheat food products with thorn-apple (Datura stramonium L.) seeds containing toxic alkaloids, atropine and scopolamine. To ensure the safe consumption of buckwheat food products, we carried out risk characterisation and proposed provisional maximum residue levels (MRLs) of atropine and scopolamine mixture in buckwheat flour. In the absence of critical "no observed adverse effect levels" for atropine and scopolamine, we based our estimation of the acute reference doses on the lowest recommended therapeutic doses. Taking into account the additive effect of the two alkaloids, we calculated acute reference doses of the mixture, that is 0.05 µg/kg of body mass for atropine and 0.03 µg/kg of body mass for scopolamine. MRLs for atropine and scopolamine mixture in buckwheat flour were estimated in a worst-case scenario, that is consumption of 100 g of flour by a child weighing 10 kg and taking into account a range of atropine/scopolamine ratio in implicated food products, that is 0.85-3.3. We proposed the national MRLs for atropine/scopolamine mixture in buckwheat food products: 4.0 µg/kg (atropine) and 2.0 µg/kg(scopolamine). However, in view of the large variability in the alkaloid content, depending on the origin of the Datura, we propose that risk assessment should be carried out on a case-by-case basis, taking into account the ratio between atropine and scopolamine content in a particular sample.

La psicosis del estramonio y los poderes públicos / Jimson weed psychosis and public authorities

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Pharmacological properties of Datura stramonium L. as a potential medicinal tree: an overview.

India has a great wealth of various naturally occurring plant drugs which have great potential pharmacological activities. Datura stramonium (D. stramonium) is one of the widely well known folklore medicinal herbs. The troublesome weed, D. stramonium is a plant with both poisonous and medicinal properties and has been proven to have great pharmacological potential with a great utility and usage in folklore medicine. D. stromonium has been scientifically proven to contain alkaloids, tannins, carbohydrates and proteins. This plant has contributed various pharmacological actions in the scientific field of Indian systems of medicines like analgesic and antiasthmatic activities. The present paper presents an exclusive review work on the ethnomedical, phytochemical, pharmacological activities of this plant.

Tósigos y antídotos en la literatura cervantina: sobre los venenos en la España tardorrenacentista / “Tosigos” and antidotes in Cervantine literature: on the poisons in the late Renaissance Spain

Los textos cervantinos constituyen una interesante fuente para el estudio de la sociedad española tardorrenacentista. Nosotros hemos abordado las obras de Cervantes desde la óptica de la toxicología, analizando el uso de agentes tóxicos y venenosos, fundamentalmente alucinógenos y narcóticos en el ámbito de la práctica de la brujería y hechicería (ungüentos de brujas, filtros de amor, pócimas venenosas, etc.), así como las menciones a las hipotéticas sustancias dotadas de acción alexifármaca, como la verbena (Verbena officinalis), el cuerno de unicornio, las piedras bezoares o el castóreo. Las obras cervantinas en las que se hace referencia a estos preparados son las novelas El Quijote, La Galatea, Viaje del Parnaso y cuatro Novelas Ejemplares (La española inglesa, El licenciado Vidriera, El celoso extremeño y El coloquio de los perros), así como en las comedias Pedro de Urdemalas, La entretenida y El laberinto del amor. Entre los agentes tóxicos de origen herbal citados expresamente por Cervantes en el contexto analizado se encuentran el beleño (Hyoscyamus niger / albus), el tabaco (Nicotiana tabacum), la adelfa (Nerium oleander), el tártago (Euphorbia lathyris), el ruibarbo (Rheum officinale, Rumex alpinus) y, de forma enmascarada, el opio (Papaver somniferum). En relación con el resto de preparados dotados de actividad tóxica, Cervantes no identifica sus ingredientes, aunque, a tenor de la sintomatología descrita por el autor, podrían ser plantas de la familia de las solanáceas, como el beleño, el solano, la datura, la belladona o la mandrágora. Con respecto a los tóxicos minerales, únicamente hay referencias a los efectos del mercurio o azogue. El Dioscórides comentado por Andrés Laguna pudo ser la fuente técnica utilizada por Cervantes para documentarse en esta materia (AU)

Cervantine texts are an interesting source for the study of Spanish late Renaissance society. We have studied the works of Cervantes from the toxicology viewpoint, analyzing the use of toxic and poisonous substances, essentially hallucinogenic and narcotic agents in the field of witchcraft and sorcery practice (witches ointments, love filters, poisonous potions, etc.), as well as references to hypothetical substances endowed with alexipharmic action, as the vervain (Verbena officinalis), unicorn horn, bezoar stones or castoreum. Cervantine works which refers to these preparations are the novels Don Quixote, The Galatea, Voyage to Parnassus and four Exemplary Novels (The Spanish-English Lady, The Licentiate of Glass, The Jealous Extremaduran and The Colloquy of the Dogs), as well as the comedies Pedro de Urdemalas, The Amusing Woman and The Labyrinth of Love. Toxic agents of herbal origin mentioned explicitly by Cervantes in the analyzed context include the henbane (Hyoscyamus niger / albus), tobacco (Nicotiana tabacum), oleander (Nerium oleander), spurge (Euphorbia lathyris), rhubarb (Rheum officinale, Rumex alpinus), and masked way, opium (Papaver somniferum). In relation to the rest of preparations endowed with toxic activity, Cervantes does not identify its ingredients, though, within the meaning of the symptoms described by the author, they could be plants of the Solanaceae family, as the henbane, nightshade, jimsonweed, belladonna or mandrake. Concerning toxic minerals, only there are references to the effects of mercury (“azogue”). The Dioscorides commented by Andrés Laguna could be the technical font used by Cervantes to document in this matter (AU)

An unusual cause of fulminant Guillain-Barré syndrome: angel's trumpet.

A 5-year-old previously healthy boy presented with typical findings of Guillain-Barré syndrome and unilateral tonic pupil. He was placed on mechanical ventilation for 35 days for respiratory failure. Plasmapheresis and two courses of intravenous immunoglobulin therapy were given to the patient, and he experienced stepwise recovery from his illness. This case of acute motor axonal neuropathy type Guillain-Barré syndrome is novel in that the cause was established as ingestion of a toxic solanaceous plant, angel's trumpet (Brugmansia suaveolens; syn. Datura suaveolens). Understanding the signs and symptoms of angel's trumpet toxicity can allow for early diagnosis and proper case management.

Intoxicaciones por plantas tóxicas atendidas desde un servicio de información toxicológica / Cases of poisoning caused by toxic plants seen at a toxicological information service

En muchos países la exposición accidental o voluntaria a sustancias tóxicas es causa frecuente de procesos patológicos agudos y crónicos, que constituyen la segunda causa de muerte, después de las enfermedades infecciosas. En reportes estadísticos predominan las intoxicaciones por psicofármacos y plaguicidas, pero existen otras como las provocadas por sustancias vegetales que también son consultas frecuentes en los servicios de urgencias(AU)

In many countries, the accidental or intentional exposure to toxic substances is the frequent cause of acute and chronic pathological processes that represent the second cause of death after the infectious illnesses. In statistical reports, poisoning from pscyho drugs and herbicides prevail, but there are others as those caused by vegetable substances that are also commonly treated in the emergency services(AU)

Intoxicaciones por plantas tóxicas atendidas desde un servicio de información toxicológica / Cases of poisoning caused by toxic plants seen at a toxicological information service

En muchos países la exposición accidental o voluntaria a sustancias tóxicas es causa frecuente de procesos patológicos agudos y crónicos, que constituyen la segunda causa de muerte, después de las enfermedades infecciosas. En reportes estadísticos predominan las intoxicaciones por psicofármacos y plaguicidas, pero existen otras como las provocadas por sustancias vegetales que también son consultas frecuentes en los servicios de urgencias...

In many countries, the accidental or intentional exposure to toxic substances is the frequent cause of acute and chronic pathological processes that represent the second cause of death after the infectious illnesses. In statistical reports, poisoning from pscyho drugs and herbicides prevail, but there are others as those caused by vegetable substances that are also commonly treated in the emergency services...

[Intentional datura stramonium intoxication and circumstances of use in two adolescents]. / Intoxication volontaire par Datura et circonstances de consommation: à propos de deux cas chez l'adolescent.

INTRODUCTION: Datura stramonium, also known as jimson weed, is a hallucinogenic plant that is increasingly used by adolescents. It is important to know how the substance is used and what the clinical signs of intoxication are to develop recommendations to avoid potentially serious side effects. CASES: We reviewed the medical files of two adolescents admitted to our university hospital after voluntary Datura intoxication. Both patients had an anticholinergic syndrome and needed in-patient surveillance, one for 8 and the other for 24 hours. One patient complained of difficulty in visual accommodation, which lasted a few days, and the other reported amnesia about the episode for a few months. DISCUSSION: Diverse indicators suggest that increasing numbers of young people are using "natural" hallucinogenic substances, most often during group initiation sessions. Because there is no reliable biological marker for the substance, diagnosis is clinical. Symptoms can persist beyond the acute phase that brought the patients to medical attention. Fortunately, the unpleasant memory of the experience generally prevents consumers from repeating it. CONCLUSION: Its easy access and the absence of legislation make Datura a tempting choice of psychoactive substance for sensation-seeking young people. To reduce its risks, professionals should recommend that Datura be used only if a non-user is present, that it not be mixed with any other drugs, and that help should be sought at the first signs of apparent intoxication. Other cases must be studied before we can determine the factors that contribute to and reduce the risk of life-threatening intoxication.

Toxicity studies on Datura metel L. with reference to official stramonium.

Suspensions of the powdered leaf of Datura metel L. and Datura stramonium L. (Solanaceae) were administered by intubation at different doses: 0.125 mg/kg, 0.250 mg/kg, 0.500 mg/kg, 1.000 mg/kg, 1.224 mg/kg and 1.400 mg/kg to virgin female albino mice and were observed daily. After two weeks, the mice were sacrificed and the liver, kidney and intestine were removed, preserved in 10% formalin solution and embedded in paraffin wax. Tissues from these organs were stained for assessment of tissue morphology. Pathological changes observed at 1.224 mg/kg and 1.400 mg/kg (LD100) were irreversible. At all other dose levels, there were reversible changes in the liver, kidney and intestine. Generally, D. metel-treated mice showed less anatomical abnormalities than D. stramonium-treated mice. Hence, D. metel could serve as a substitute for D. stramonium in drug development.

Dos casos de intoxicación por contaminación de maíz con Datura stramonium en ganado vacuno / Two cases of poisoning by Datura stramonium contaminated corn in cattle

Recientemente hemos observado dos intoxicaciones en ganado vacuno lechero, en granjas de Cataluña, debidas a la ingestión de estramonio (Datura stramonium). La planta había sido en ambos casos erróneamente recolectada junto con el maíz empleado para la alimentación de los animales. El cuadro fue leve y, básicamente, cursó con problemas digestivos y descenso en la producción lechera, y remitió con la retirada del alimento contaminado. Debido a factores ambientales y económicos, el problema podría estar en aumento(AU)

Recently, two poisoning episodes produced by Jimson weed (Datura stramonium) consumption have been observed in dairy cattle farms from Catalonia. The plant was mistakenly gathered, in both cases, together with corn used for animal feed. The set of symptoms were slight, basically gastrointestinal disorders and decrease of milk production, and animal recovery was observed as soon as the contaminated feed was removed. This problematic situation could be increasing in prevalence due to environmental and economic factors(AU)

Studies on some paraclinical indices on intoxication in horses from freshly cut Jimson weed (Datura stramonium)-contaminated maize intended for ensiling.

Monitoring of changes in some blood laboratory parameters in 34 horses after ingesting freshly harvested maize that was to be used for ensiling, heavily contaminated with young Datura stramonium plants, is described. For a 7-day period the following parameters were monitored: haemoglobin content (HGB), red blood cell counts (RBC), white blood cell counts (WBC), haematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), differential white cell counts (DWC), erythrocyte sedimentation rate (ESR), protein fractions, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), total bilirubin (TB), direct bilirubin (DB), blood glucose (Glu), total protein (TP), globulin (Glob) and albumin (Alb). The intoxication was accompanied by erythrocytosis, leukocytosis, regenerative left shift neutrophilia, lymphopaenia, eosinopaenia, increased haematocrit values, low erythrocyte sedimentation rate, hyperglycaemia, bilirubinaemia, hypoproteinaemia and increased activity of AST and LDH. No changes occurred in the mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), albumin, globulin and globulin fractions (alpha 1, alpha 2, beta 1, beta 2 and gamma). The blood parameters returned to normal between post-intoxication days 2 and 5. The observed changes in clinical chemistry indices could be used in the diagnosis, differential diagnosis and prognosis of Jimson weed intoxication.

Anisocoria in the dog provoked by a toxic contact with an ornamental plant: Datura stramonium.

We report an unusual case of anisocoria in the dog provoked by Datura stramonium, and an experimental clinical assay to reproduce the anisocoria using simple contact with part of the plant in four healthy dogs. Any part of the D. stramonium plant produced anisocoria following simple contact with the eye.

Brujas de Salem, escobas voladoras y drogas de síntesis / Synthetic drugs

Se efectúa una recopilación histórica sobre diversos aspectos relacionados con la L.S.D. y el estramonio. Los "tripis", Special K y otras pastillas de síntesis contienen las sustancias anteriormente citadas. La historia de estos principios activos alucinógenos está muy ligada a la mitología de la hechicería, a las brujas y a la intolerancia religiosa. Esta revisión quiere describir curiosidades históricas y acabar con la creencia de nuestros jóvenes de que dichas sustancias son nuevas, nada peligrosas, drogas inventadas en los siglos XX y XXI, sin toxicidad y de primera línea. (AU)

An outbreak of acute toxicity caused by eating food contaminated with datura stramonium

The authors report methods used to characterize an outbreak of food-borne acute toxicity among the labour force of a cotton plantation in Middle Awash Agricultural Development Enterprise in July and August 1984. Among 1492 patients seen at the Enterprise and Ministry of Health clinics during this period; 688 (46.1 per cent) exhibited unusual signs and symptoms. Thirty three patients required hospitalization for intensive medical care while nine patients were reported to have died due to this condition.Contamination of corn flour with pesticides was initially suspected and laboratory animal tests were carried out which failed to show any signs of acute toxicity. Investigation of the source of the corn and its processing was simultaneously conducted and revealed the contamination of the corn with seeds of an indigenous plant identified as Datura stramonium; an antimuscarinic alkaloid. These alkaloids contain hyoscine and hyoscyamine which is known to have toxic effect on the exocrine glands; heart; and the autonomic nervous system in man. Signs and symptoms observed in the patients and preventive measures implemented are discussed