Electromyographic and laboratory findings in acute Solanum torvum poisoning.

CONTEXT: Solanum torvum berries, known as susumber or turkey berries, are prepared as part of traditional Jamaican dishes usually served with cod and rice. Poisoning is rare. Although toxic compounds have never been definitively isolated, previous reports suggest toxicity results from inhibition of acetylcholinesterases. We present a case of susumber berry poisoning with detailed electromyographic studies and laboratory analysis. CASE DETAILS: A 54-year-old woman presented to the Emergency Department (ED) complaining of vision, speech, and gait changes; emesis; and diffuse myalgias following consumption of susumber berries. The physical examination demonstrated an intact, lucid mental status, miosis, opsoclonus, severe dysarthria, dysmetria, mild extremity tenderness and weakness, and inability to ambulate. Her symptom constellation was interpreted as a stroke. DISCUSSION: Electromyography demonstrated a pattern of early full recruitment as well as myotonia during the period of acute toxicity. Additionally, solanaceous compounds, in particular solasonine and solanidine, were identified in leftover berries and the patient's serum. Store-bought commercial berries and subsequent serum samples were free of such toxic compounds. EMG studies, together with a laboratory analysis of berries or serum can assist in the differential diagnosis of stroke, and provide both a prognostic screening and confirmation of suspected glycoside toxicity.

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.

Calbindin D28k expression and the absence of apoptosis in the cerebellum of Solanum bonariense L-intoxicated bovines.

Solanum bonariense intoxication is characterized by cerebellar neuronal vacuolation, degeneration, and necrosis. Cerebellar Purkinje cells seem especially susceptible, but more research is needed to determine the pathogenesis of neuronal necrosis and the mechanism of Purkinje cell susceptibility. Calbindin D28k (CbD28k) is highly expressed in Purkinje cells and has been used as a marker for normal and degenerative Purkinje cells. The goal of this study was to describe S bonariense-induced disease by ascertaining Purkinje cell-specific degenerative changes using CbD28k expression and to correlate this with apoptosis in Purkinje cells, as determined using TUNEL (transferase-mediated dUTP-biotin nick end-labeling) and ultrastructural changes. In all cases, an increase in both dose and duration of S bonariense intoxication resulted in a decrease in the number of Purkinje cells. CbD28k immunohistochemistry was an excellent marker for Purkinje cells because immunoreactivity did not change in normal or degenerative tissues. This finding suggests that excessive calcium excitatory stimulation does not induce rapid neuronal degeneration and death. As found in previous studies, TUNEL tests and electron microscopy suggest that Purkinje cell degeneration and death are not occurring via an apoptotic process. These findings suggest that S bonariense poisoning induces progressive Purkinje cell death that is not mediated by excitotoxicity or apoptotic activation.

Solanaceous steroidal glycoalkaloids and poisoning by Solanum torvum, the normally edible susumber berry.

Ingestion of immature, environmentally stressed, or cultivar-specific Solanum species (particularly the potato) has been previously associated with gastrointestinal and neurological symptoms caused by solanaceous steroidal glycoalkaloids (SGAs). We report on two geographically, temporally disparate outbreaks of poisoning by susumber berries (Solanum torvum- Solanaceae) and on detection of alkaloids not present in non-toxic berries. Five family members in New York City participated in a traditional evening meal containing Jamaican susumber berries. All those consuming berries were symptomatic the following morning with varying degrees of gastrointestinal distress, dizziness, slurred speech, cranial nerve deficits, and ataxia. The most seriously afflicted patient developed hypertension, confusion, proximal upper extremity weakness, and hypercapnic respiratory failure requiring prolonged mechanical ventilation. A separate cohort of six patients in Toronto ate unripe Jamaican susumber berries. They presented 14h post-ingestion with varying degrees of diarrhea, weakness, facial paralysis, slurred speech, ataxia, early hypertension, and proximal weakness. Two patients had ventilatory decompensation; one required intubation. Poisonous berries appeared indistinguishable from non-toxic varieties. We isolated solasonine, larger amounts of solamargine, and other steroidal glycoalkaloids in the toxic berry strains. S. torvum poisoning can produce significant neurological and gastrointestinal effects which appear to be mediated by SGAs present in the berries.

Central diabetes insipidus following digestion Solanum indicum L. concentrated solution.

In Taiwan, Solanum indicum L. has been used in folk medicine for the treatment of inflammation, toothache, ascites, edema, and wound infection. The plant is rich in solanine, an alkaloidal glycoside. We report a 43-year-old man who developed polyuria and polydipsia after taking seven doses of concentrated solution of Solanum indicum L. over two weeks. A water deprivation test and a low serum antidiuretic hormone level helped to confirm a diagnosis of central diabetes insipidus. We suggest that excessive doses of Solanum indicum L. may cause central diabetes insipidus.

Collagenous and elastic system fibres in the aorta of cattle poisoned by Solanum glaucophyllum.

The proportions of fibres of the collagenous and elastic systems were measured in the aortas of three normal heifers and in nine heifers given the calcinogenic plant Solanum glaucophyllum for 15, 30 or 60 days. There were decreases in the amount of collagen relative to reticulin, and in the proportion of elastic fibres which were related to the period of dosing. These changes may have an adverse influence on the animals' cardiovascular function.

A female with central anticholinergic syndrome responsive to neostigmine.

Central anticholinergic syndrome is a rarely observed condition in children. The occurrence of this syndrome after ingestion of Solanum pseudocapsicum is infrequent because findings tend to be milder and localized to the gastrointestinal system, without central nervous system involvement. Most patients do not present with diagnostic problems because their relatives can usually report any ingestion of poisonous agents; however, when drug poisoning or plant ingestion is uncertain, a differential diagnosis with encephalitis must be considered. Physostigmine salicylate is the specific antidote because it crosses the blood-brain barrier because of its tertiary ammonium group. Neostigmine methylsulfate has a quaternary ammonium group, which prevents its penetration through the blood-brain barrier; hence its primary influence is believed to be due to its action on the peripheral nervous system. We describe a female with central anticholinergic syndrome caused by ingestion of Solanum pseudocapsicum. A slow intravenous infusion of neostigmine methylsulfate (0.03 mg/kg) immediately resolved the clinical picture. To our knowledge, this case is the first reported of central anticholinergic syndrome occurring after ingestion of Solanum pseudocapsicum in a child and the first report of a complete and rapid remission after intravenous neostigmine methylsulfate administration.

[Solanine and chaconine: occurrence, properties, methods for determination]. / Solanina i chakonina--wystepowanie, wlasciwosci, metody oznaczania.

Glycoalkaloids are naturally occurring toxicants in plants that are members of the Solanaceae family. In this paper occurrence of glycoalkaloids, especially solanine and chaconine in potatoes and tomatoes, were reviewed. Basing on literature, toxicological properties and methods of determination were reported. Attention was paid to common content of glycoalkaloids in potatoes and tomatoes and their commercial products. Solanine and chaconine are usually present at low levels in large majority of current commercial varieties but they can accumulate to high levels in greened, stored, damaged potatoes. High concentration may cause acute poisoning, including gastro-intestinal and neurological disturbances, in man. The upper limit, recognized as a safe (non-toxic), was presented. According to WHO normal levels in potatoes 20-100 mg per kg of potatoes is not of toxicological concern.

Love potions and the ointment of witches: historical aspects of the nightshade alkaloids.

BACKGROUND: Nightshade plants (Solanaceae) have been utilized as hallucinogenic drugs since antiquity in nearly every culture. The Solanaceae alkaloids, atropine and scopolamine, were the active substances in ointment of witches and medieval anesthetics, and in modern poisons. They are still currently used as hallucinogenic drugs. In poisonings, a dosage- and substance-dependent clinical picture occurs, with central and peripheral symptoms. Hallucinations are predominant in the middle dose range, which explains the drugs' earlier utilization for religious and prophetic purposes. Respiratory depression and arrest at high doses confirm the use of scopolamine as a lethal poison. Despite this, the nightshade alkaloids were utilized in clinical medicine in the 19th century. This is an overview of the cultural history of the nightshade alkaloids.

Anticholinergic toxicity from nightshade berry poisoning responsive to physostigmine.

The woody nightshade, Solanum dulcamara, belongs to the genus Solanum and its primary toxin is solanine. We report a large nightshade ingestion in a 4-yr-old girl who presented to the emergency department in acute anticholinergic crisis. The child was given 0.2 mg of intravenous physostigmine (0.02 mg/kg). Within 50 min, the patient received two additional equal doses with complete resolution of symptoms. After 36 h of observation, the child was discharged. Our patient presented with symptoms more suggestive of the deadly nightshade species, Atropa belladonna, which is native to Europe; however, a detailed laboratory analysis of the suspect berries revealed no atropine or hyoscyamine. Analysis did reveal sterols consistent with solanine. This is a unique case presentation of woody nightshade, S. dulcamara, poisoning presenting with anticholinergic crisis and responding to physostigmine.

Alteraçöes ultra-estruturais do miocárdio na intoxicaçäo experimental de coelhos pela planta calcinogênica Solanum malacoxylon / Ultrastructural changes in the myocardium in the experimental poisoning of rabbits by calcinogenic plant Solanum malacoxylon

Seis coelhos com cerca de três meses, de ambos os sexos, receberam via sonda gástrica, extrato aquoso de Solanum malacoxylon equivalente a 100 mg de folhas dessecadas por kg de peso vivo. Dois animais näo receberam o extrato e serviram como testemunhas, sendo sacrificados ao final do experimento. Entre 48, 72 e 120 horas após o início do experimento, todos os outros coelhos foram sacrificados e fragmentos do miocárdio foram processados para microscopia óptica e eletrônica. As alteraçöes macroscópicas mais importantes foram estrias esbranquiçadas no miocárdio, particularmente no átrio esquerdo. Em microscopia óptica, grupos de células musculares mostravam sarcoplasma tumefeito, com perda das estriaçöes, discreta basofilia e eventualmente vacuolizaçöes do sarcoplasma. Estas células geralmente estavam rodeadas por macrófagos, células mesenquimais e alguns polimorfonucleares neutrófilos de permeio com material necrótico. No interstício foi evidenciado material basofílico finamente granular. A reaçäo de von Kossa nestes locais revelou depósitos de cálcio no sarcoplasma dos miócitos, no interstício e, eventualmente, ao redor de células musculares aparentemente näo lesadas. Os vasos coronários exibiam mineralizaçäo da média. Na ultra-estrutura foram observadas: ativaçäo dos cardiomiócitos e das células intersticiais, deposiçäo do cálcio no interstício e no sarcoplasma das células musculares cardíacas e no cistoplasma de células intersticiais. Em fases mais avançadas observou-se necrose dos cardiomiócitos, com mineralizaçäo das células e lise celular. Alguns polimorfonucleares neutrófilos e macrófagos fagocitando material necrótico mineralizado säo também vistos nestes locais. O aspecto morfológico do miocárdio sugere que as lesöes de necrose e calcificaçäo säo o resultado da açäo direta do 1,25(OH)2D3 contido na planta sobre as células do miocárdio. Os animais testemunhas näo exibiram alteraçöes no miocárdio

[Psychopathologic manifestations of oral administration of endemic nightshade plants]. / Psychopathologische Befunde nach oraler Aufnahme von Inhaltsstoffen heimischer Nachtschattengewächse.

Psychopathological findings in two cases of oral poisoning with toxins of "Datura stramonium" (thorn apple) and "Hyoscyamus niger" (insane roof) are reported. Toxicological aspects of voluntary ingestion are discussed as well as the forensic importance of criminal poisoning.