Mohamad, Nasir
(2011)
Anticholinergic toxidromeofdatura toxicity: neostigmine
reverses its toxicity.
Other.
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia.
Abstract
Datura belongs to ihe family of solanacae or"Kecubung" in Malaysia or"Trompetbloem" in Surinam.
It is rich in alkaloids and terpenes and is often used for pulmonary conditions such as bronchial asthma.
The seeds are ihe most toxic part of the plant as I 00 seeds contain ihe equivalence of approximately 6
mg of atropine. The main active chemicals present in datura are ihe tropane alkaloids scopolamine,
atropine, and hyoscamine. Scopolamilie and atropine are anticholinergic deleriants. They block
muscarinic receptors, which in turn excite dopaminergic neurons. They are readily absorbed, partially
metabolized by ihe liver, and mostly eliminated in ihe urine, wiih a half-life of about four hours.
We describe a case of acute datura ingestion in a 48 year-old gentleman presented to our emergency
department after he allegedly consumed 4 fruits of datura. One hour after ingestion, he developed
generalized muscle weakness associated wiih altered sensorium, his GCS was I 0115. On examination,
he was found to be restless, dilated pupils of 4 mm in diameter. He was hyperihermic (T=38°C),
tachycardic !HJR=lOO beats per minute), blood pressure of 130/80 mmHg, tachypnoiec (RIR=26),
~sence of neck stiffuess, dried and coated tongue and presence of urinary retention.
In datura toxicity, life-ihreatening events require P.rompt supportive management The use of
neostigmine as acetylcholinesterase inhibitor in an anti-cholinergic intoxication is reported to
effectively reverse ihe effect of anti-cholinergic toxidrome. The doses and frequency of neostigmine
administration can be titrated according to the clinical progress and improvement. Onr patient
responded well to ihe regime given. Careful titration of ihe drug is required. Too high doses of
neostigmine cause severe bradycardia, which may require intravenous atropine.
In conclusion, early detection of toxicity (toxidrome) and a good history taking remain the most
important elements in the diagnosis of datura toxicity in ihe Emergency Department. Delay in
recognizing toxicity of datura may lead to serious morbidity and mortality.
Actions (login required)
 |
View Item |
