The "Blown Pupil": Imminent Death or Harmless Contamination?

Acute anisocoria and unilateral mydriasis is physically alarming to patients and diagnostically worrisome to clinicians. We report the case of a 14-year-old girl who presented to the pediatric emergency department with acute anisocoria and unilateral mydriasis after contacting an Angel's trumpet plant and who had complete resolution of symptoms four days following eye contamination. The Angel's trumpet plant contains three active components which can result in mydriasis: hycosamine, atropine, and scopolamine. The three active components occur in different parts of the plant, including on the small glandular hairs that cover the entire plant. This likely explains why even brief contact with the plant can result in unintentional contamination of the eye and in mydriasis. It is critical when obtaining a history from a patient with such a presentation to ask explicitly about any contact with plants prior to onset of symptoms. Although eye contamination with the Angel's trumpet plant is self-limited and resolves within a week, the appearance of a persistently unilateral mydriatic eye can be alarming to patients and clinicians, which too often results in an unnecessary, costly workup.

Datura and Brugmansia plants related antimuscarinic toxicity: an analysis of poisoning cases reported to the Taiwan poison control center.

INTRODUCTION: Datura and Brugmansia plants, especially Datura species, have been used for their hallucinogenic effects in the United States and Europe; whereas Datura plants have been used as a traditional medicine in many Asian countries. This study was conducted to better understand the pattern and outcome of Datura/Brugmansia plant related poisoning in Taiwan. METHODS: This is a retrospective case series study of all cases with Datura/Brugmansia exposure reported to the Taiwan Poison Control Center between 1986 and 2015. Data for patients with relevant poisoning were reviewed and abstracted. Logistic regression analysis was used to identify potential predictors of the severity of poisoning; bivariate analysis was employed to assess the effectiveness of physostigmine in the treatment of Datura/Brugmansia poisoning. RESULTS: A total of 203 cases involving 114 Datura exposures and 89 Brugmansia suaveolens exposures were eligible for analysis. Using Datura/Brugmansia for a medicinal purpose by the patients without consulting Chinese medicine practitioners was the most common reason of poisoning (81.2%); whereas only 2% of the patients were poisoned after medicinal use associated with the prescription from Chinese medicine practitioners. None of the 203 patients had used Datura/Brugmansia plant for recreational purpose. Most frequently observed clinical effect was mydriasis (53.2%), followed by confusion (40%), tachycardia (35.5%), dry mouth (35.5%), dizziness (34%), dry skin (32.5%), and delirium (31%). Seventy-three cases (36%) had severe effects; none of them died. Misidentification of the plants and ingestion of plant parts other than flowers were positively associated with the severity of poisoning. Forty patients (19.7%) received physostigmine therapy and patients receiving physostigmine had an earlier resolution of central nervous system toxicity than those who did not. CONCLUSIONS: Medicinal use without consulting Chinese medicine practitioners is the main reason for Datura/Brugmansia poisoning in Taiwan. Consumption of parts other than flowers and misidentification of the plants predicted the severity of poisoning in this study. Patients who received physostigmine appear to have earlier improvement in the central nervous system effects. No adverse events were reported from physostigmine administration.

Datura fruit poisoning.

Datura plants contain anticholinergic properties. Consumers may present with a spectrum of anticholinergic symptoms, including hallucination, agitation, tachycardia, delirium, hyperthermia, and dilated pupils. Prompt identification of the symptoms with appropriate treatment can be life-saving. Some patients might not be able to provide history and therefore recognition of toxidromes is imperative. Awareness should be built among the public who may be exposed to such fruits or plants.

Identification of Datura Species Involved in a Food-Poisoning Case Using LC-MS/MS and DNA Barcording.

A food-poisoning case due to eating the roots of Datura occurred in Kawasaki City, Japan in 2014. The Datura plant was mistakenly collected instead of burdock in a domestic garden. The roots of these plants are quite similar to each other. We presumed that the specimen was the root of Datura, but it was difficult to classify it only from the morphology. Using LC-MS/MS, we detected atropine and scopolamine from the remaining plant specimen. Therefore, we applied the DNA barcoding method. The results showed that the specimen was classified into Solanaceae family, but not Asteraceae family. Thus, the specimen was confirmed to be Datura species based on both chemical and genetic analyses.

Forensic features of a fatal Datura poisoning case during a robbery.

Datura poisonings have been previously described but remain rare in forensic practice. Here, we present a homicide case involving Datura poisoning, which occurred during a robbery. Toxicological results were obtained by second autopsy performed after one previous autopsy and full body embalmment. A 35-year-old man presented with severe stomach and digestive pain, became unconscious and ultimately died during a trip in Asia. A first autopsy conducted in Asia revealed no trauma, intoxication or pathology. The corpse was embalmed with methanol/formalin. A second autopsy was performed in France, and toxicology samples were collected. Scopolamine, atropine, and hyoscyamine were found in the vitreous humor, in addition to methanol. Police investigators questioned the local travel guide, who admitted to having added Datura to a drink to stun and rob his victim. The victim's death was attributed to disordered heart rhythm due to severe anticholinergic syndrome following fatal Datura intoxication. This is a recent case of a rare homicide involving Datura that highlights general information on Datura and discusses forensic interpretation after a previous autopsy and body embalmment.

[Trends of plant toxin food poisonings during the past 50 years in Japan].

In the present study, we reviewed food poisoning data published by the Ministry of Health, Labour and Welfare of Japan from 1961 to 2010 in Japan to analyze the trends of plant toxin food poisonings (PTFPs). The annual number of incidents of PTFPs has gradually increased since 1995. PTFPs were predominantly caused by Datura spp., Veratrum spp. and Aconitum spp. Although PTFPs frequently occurred in April and May, poisonings caused by some plants occurred in all seasons, e.g. Datura spp. The major location of PTFPs was "at home", and most of the patients had accidentally harvested poisonous plants. During the past decade, the numbers of incidents of PTFPs caused by Veratrum spp., Narcissus spp., Solanum tuberosum and Alocasia odora were especially increased. Consumer advice to prevent PTFPs associated with certain plants that are cultivated in gardens and contain toxic substances is needed, because PTFPs caused by such plants are increasing. In addition, education of elementary school teachers and children about the potential risks of natural toxins in plants, particularly Solanum tuberosum, is desirable.

[Datura intoxication--report of three cases]. / Zatrucie bieluniem dziedzierzawa--opis trzech przypadków.

In recent months, more and more reports have appeared about datura seed poisoning. Datura is widespread and has hallucinogenic properties. It is part of the increase in drug use among the younger generation that is experimenting with intoxicants. The hallucinogenic and poisonous effects of datura involve the presence of tropine alkaloids: atropine and scopolamine. They both have similar effects, suppressing the parasympathetic peripheral nervous system. In large doses they lead to death as a result of respiratory paralysis. Treatment addresses the symptoms. In order to eliminate toxic effects of atropine, an antagonistic medication such as neostigmine is given.

Mass intoxication with Datura innoxia--case series and confirmation by analytical toxicology.

BACKGROUND: Anticholinergic plants contain a variety of alkaloids that are toxic if ingested. Datura innoxia belongs to the family of Solanaceae and contains two main toxic alkaloids, atropine and scopolamine. CASE SERIES: In this study we report the case series of seven individuals who were admitted to two different hospitals of Athens with an anticholinergic syndrome. All symptoms manifested after consumption of cooked vegetables (blites). INVESTIGATION: The investigation of the cases revealed that among the vegetables there was also Datura innoxia, which has a similar appearance to blites. Urine and plasma samples of the seven patients, as well as a sample of cooked vegetables, were analyzed with gas chromatography-mass spectrometry. Atropine and scopolamine were confirmed in all urine and vegetable samples, but not in plasma probably because of the delay in sample collection. The urine samples of all patients contained atropine in concentrations between 67.1 and 691.7 ng/mL, while urine concentrations of scopolamine ranged from 32.4 to 186.4 ng/mL. The concentrations of atropine and scopolamine in the cooked vegetables were found to be 0.8 and 1.2 microg/g, respectively. CONCLUSION: All patients recovered completely, although some required mechanical ventilation. The investigation and the presentation of this case series illustrate not only mass intoxication with D. innoxia, but also the utility of analytical toxicology. It also illustrates the dangers of collection of vegetables in the wild.

A traditional Malay myth leading to unintentional self intoxication with kecubung fruit.

Traditional Malay herbal medicine is still used in Malaysia especially in rural areas, instead of using modern medicine. Datura or "kecubung" has been used to treat allergic rhinitis in certain places. Inaccurate doses can potentially cause severe or fatal neurologic anti-cholinergic toxidromes. A good knowledge of toxidromes with optimization of supportive care can prevent fatal complications and lead to a more speedy recovery. We present a case of kecubung poisoning.

[Retrospective study of two cases of acute datura poisoning].

We saw 2 cases of datura poisoning, with the main complaint of impaired consciousness, which were brought to the emergency department of this hospital. The poisonous constituent of the datura is tropane alkaloid, which is said to have a short half-life period that makes it difficult to determine its quantity in the blood or urine. We stored the urine and blood specimens taken when the patients were brought in and sent them for analysis at a public health center a few days later. The determined amounts for both patients are as follows. Case 1: serum atropine, 70 ng/mL; scopolamine, 210 ng/mL; urine atropine, 0.34 mg/L; scopolamine, 0.11 mg/L. Case 2 : serum atropine, 60 ng/ mL ; scopolamine, 380 ng/mL ; urine atropine, 0.22 mg/L ; scopolamine, 0.14 mg/L. We attempted to compare these results with literature on the possible measurement of a determined amount in light of comparative considerations of the correlation between blood concentration and clinical conditions, but encountered some difficulties due to the lack of available reports. However, as our own experiment cases are retrospective we report them as valuable cases in which it is possible to obtain a determined amount of tropane alkaloid.

Two instances of Chinese herbal medicine poisoning in Singapore.

Datura metel L. (Yangjinghua) is a toxic herb that contains anticholinergic compounds. Inappropriate consumption of this herb could result in anticholinergic poisoning. Clinical features of such poisoning have not been previously described. We report two such cases. Both patients had taken brews of Datura metel L., and developed poisoning soon afterwards. Prominent clinical features included confusion, dilated pupils, absence of sweating, and the absence of sluggish bowel sounds. No flushing of the face or skin was detected in either case. Both patients recovered fully within 12 hours with supportive measures, and no gastric elimination or antidote was used. The different names ascribed to Datura metel L. in chinese medicine can be confusing; this confusion resulted in the poisoning of one of our patients. The clinical features of Datura metel L. poisoning and concerns over inappropriate uses of herbal medicine are discussed.

Confirmed Datura poisoning in a horse most probably due to D. ferox in contaminated tef hay.

Two out of a group of 23 mares exposed to tef hay contaminated with Datura ferox (and possibly D. stramonium) developed colic. The 1st animal was unresponsive to conservative treatment, underwent surgery for severe intestinal atony and had to be euthanased. The 2nd was less seriously affected, responded well to analgesics and made an uneventful recovery. This horse exhibited marked mydriasis on the first 2 days of being poisoned and showed protracted, milder mydriasis for a further 7 days. Scopolamine was chemically confirmed in urine from this horse for 3 days following the colic attack, while atropine could just be detected for 2 days. Scopolamine was also the main tropane alkaloid found in the contaminating plant material, confirming that this had most probably been a case of D. ferox poisoning. Although Datura intoxication of horses from contaminated hay was suspected previously, this is the 1st case where the intoxication could be confirmed by urine analysis for tropane alkaloids. Extraction and detection methods for atropine and scopolamine in urine are described employing enzymatic hydrolysis followed by liquid-liquid extraction and liquid chromatography tandem mass spectrometry (LC/MS/MS).