Jimson weed

Background

Datura stramonium aka Jimson Weed

• 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)

Clinical Features

• 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

Anticholinergic toxicity Causes

• Medications
  • Atropine
    • Lomotil toxicity
  • Antihistamines
  • Antidepressants
    • Tricyclic antidepressant (TCA) toxicity
    • Selective serotonin reuptake inhibitor toxicity
  • Antipsychotics
  • Muscle relaxants
  • Anti-Parkinsonians
• Plants
  • Jimson weed (Devil's trumpet)
  • Amanita mushroom

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)