Document Detail


Presumed Angel's trumpet (Brugmansia) poisoning: clinical effects and epidemiology.
MedLine Citation:
PMID:  14631706     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the pattern and epidemiology of anticholinergic plant poisoning, and to characterize its time course and clinical features. METHODS: We reviewed all anticholinergic plant poisonings using a prospective database of all poisonings admitted to a major toxicology unit in Australia. All patients that presented with anticholinergic plant poisoning between July 1990 and June 2000 were included. Patient demographics, details of poisoning, diagnostic clinical features, adverse effects (seizures, arrhythmias, hypotension, accidental injury), and treatments required were obtained. Important diagnostic features were analysed and compared to previous studies. RESULTS: Thirty-three patients were presumed to have ingested Brugmansia spp. (Angel's trumpet) based on their description of the plant; median age 18 years (interquartile range 16-20); 82% males. Thirty-one ingested a brewed tea or parts of the plant (flower). Thirty-one used it recreationally. Common clinical features were: mydriasis (100%), mean duration 29 h (SD 13) and delirium (88%) with a mean duration of 18 h (SD 12). Tachycardia only occurred in 11 of the 33 patients (33%). In 24 patients where the time of ingestion was certain, 7 of 8 (88%) patients presenting within 5 h had tachycardia and only 5 out of 16 (31%) presenting after 5 h had tachycardia. There were no deaths, seizures or arrhythmias (excepting tachycardia). One patient had hypotension and two sustained accidental traumatic injuries. Nineteen patients required sedation, mainly with benzodiazepines. Physostigmine was used diagnostically in eight cases. CONCLUSIONS: Anticholinergic plant abuse is sporadic in nature. Most cases were moderate in severity, requiring sedation only, and severe toxicity was rare. Mydriasis and delirium were the commonest features, the later having important implications for management.
Authors:
Geoffrey K Isbister; Patrick Oakley; Andrew H Dawson; Ian M Whyte
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Emergency medicine (Fremantle, W.A.)     Volume:  15     ISSN:  1035-6851     ISO Abbreviation:  Emerg Med (Fremantle)     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-11-24     Completed Date:  2004-09-09     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9421464     Medline TA:  Emerg Med (Fremantle)     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  376-82     Citation Subset:  IM    
Affiliation:
Discipline of Clinical Pharmacology, University of Newcastle, Department of Clinical Toxicology and Pharmacology, Newcastle Mater Misericordiae Hospital, Newcastle, New South Wales, Australia. gsbite@bigpond.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Australia / epidemiology
Cholinergic Antagonists / poisoning
Emergencies
Female
Humans
Male
Plant Structures / poisoning
Poisoning / epidemiology,  physiopathology
Prospective Studies
Solanaceae / poisoning*
Chemical
Reg. No./Substance:
0/Cholinergic Antagonists

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