https://doi.org/10.4081/ecj.2022.10292
A sabbath in the emergency room or a case of anticholinergic toxicity?
Submitted: 21 November 2021
Accepted: 1 February 2022
Published: 29 March 2022
Accepted: 1 February 2022
Abstract Views: 652
PDF: 285
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
We report the case of a 32-year-old Italian man admitted to our emergency room for visual disturbances with blurred vision, anisocoria and temporal headache suddenly occurred in absence of other neurological symptoms. A diagnosis of Datura stramoniuminduced anticholinergic toxicity was done. With our work, we want to highlight the importance of a meticulous clinical examination, including papillary diameter and reflexes, combined with a detailed history of the patient in the emergency room. Anticholinergic toxicity is a medical emergency. The diagnosis is always clinical, and it can represent a challenge for the emergency clinicians because it can mimic several neurological diseases, including acute stroke and seizures, but early diagnosis is crucial to avoid severe complications and management errors.
Marchlewski MB. Anticholinergic syndrome. Avoiding misdiagnosis. J Psychosoc Nurs Ment Health Serv 1994;32:22-4.
DOI: https://doi.org/10.3928/0279-3695-19940901-09
Schmoll S, Romanek K, Zorn G, Eiglmeier H, Eyer F. Anticholinergic syndrome after atropine overdose in a supposedly homeopathic solution: a case report. Clin Toxicol (Phila) 2021;14:1-3.
DOI: https://doi.org/10.1080/15563650.2021.1918704
Soulaidopoulos S, Sinakos E, Dimopoulou D, et al. Anticholinergic syndrome induced by toxic plants. World J Emerg Med 2017;8:297-301.
DOI: https://doi.org/10.5847/wjem.j.1920-8642.2017.04.009
Jerzykiewicz J. Alkaloids of Solanaceae (nightshade plants). Postepy Biochem 2007;53:280–6.
Jeong TO, Lee JB, Jin YH, Yoon JC. Anticholinergic syndrome following ingestion of Lamprocapnos spectabilis (Bleeding Heart). Clin Toxicol (Phila) 2015;53:842-3.
Pigatto AGS, Blanco CC, Mentz LA, Soares GLG. Tropane alkaloids and calystegines as chemotaxonomic markers in the Solanaceae. An Acad Bras Cienc 2015;87:2139–49.
DOI: https://doi.org/10.1590/0001-3765201520140231
Chang SS, Wu ML, Deng JF, Lee CC, et al. Poisoning by Datura leaves used as edible wild vegetables. Vet Hum Toxicol 1999;41:242–5.
He J, Hou XY. The potential contributions of traditional Chinese medicine to emergency medicine. World J Emerg Med 2013;4:92–7.
DOI: https://doi.org/10.5847/wjem.j.i8ssn.1920-8642.2013.02.002
Gowdy JM. Stramonium intoxication: review of symptomatology in 212 cases. JAMA 1972;221:585–7.
DOI: https://doi.org/10.1001/jama.221.6.585
Disel NR, Yilma M, Kekec Z, Karanlik M. Poisoned after dinner: Dolma with datura stramonium. Turk J Emerg Med 2016;15:51–5.
DOI: https://doi.org/10.5505/1304.7361.2015.70894
Rakotomavo F, Andriamasy C, Rasamoelina N, Raveloson N. Datura stramonium intoxication in two children. Pediatr Int 2014;56:e14–6.
DOI: https://doi.org/10.1111/ped.12363
Ramirez M, Rivera E, Ereu C. Fifteen cases of atropine poisoning after honey ingestion. Vet Hum Toxicol 1999;41:19–20.
Pereira CA, Nishioka S de D. Poisoning by the use of Datura leaves in a homemade toothpaste. J Toxicol Clin Toxicol 1994;32:329–31.
DOI: https://doi.org/10.3109/15563659409017969
Acikalin A, Gulen M, Kara B, et al. Anticholinergic syndrome and supraventricular tachycardia caused by lavender tea toxicity. Keio J Med 2012;61:66-8.
DOI: https://doi.org/10.2302/kjm.61.66
Diker D, Markovitz D, Rothman M, Sendovski U. Coma as a presenting sign of Datura stramonium seed tea poisoning. Eur J Intern Med 2007;18:336–8.
DOI: https://doi.org/10.1016/j.ejim.2006.09.035
Pekdemir M, Yanturali S, Akay S, et al. Acute anticholinergic syndrome due to Datura innoxia Miller mixed with lime tea leaves. Vet Hum Toxicol 2004;46:176–7.
Guharoy SR, Barajas M. Atropine intoxication from the ingestion and smoking of jimson weed (Datura stramonium). Vet Hum Toxicol 1991;33:588–9.
Shervette RE, Schydlower M, Fearnow RG, Lampe RM. Jimson “loco” weed abuse in adolescents. Pediatrics 1979;63:520–3.
DOI: https://doi.org/10.1542/peds.63.4.520
Trabattoni G, Visintini D, Terzano GM, et al. Accidental poisoning with deadly nightshade berries: a case report. Hum Toxicol 1984;3:513–6.
DOI: https://doi.org/10.1177/096032718400300607
Mateo Montoya A, Mavrakanas N, Schutz JS. Acute anticholinergic syndrome from Atropa belladonna mistaken for blueberries. Eur J Ophthalmol 2009;19:170–2.
DOI: https://doi.org/10.1177/112067210901900130
Caksen H, Odabaş D, Akbayram S, et al. Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol 2003;22:665–8.
DOI: https://doi.org/10.1191/0960327103ht404oa
Berdai MA, Labib S, Chetouani K, Harandou M. Atropa Belladonna intoxication: A case report. Pan Afr Med J 2012;11:72.
Adegoke S, Alo L. Datura stramonium poisoning in children. Niger J Clin Pract 2013;16:116–8.
DOI: https://doi.org/10.4103/1119-3077.106783
Holstege CP, Borek HA. Toxidromes. Crit Care Clin 2012;28:479-98.
DOI: https://doi.org/10.1016/j.ccc.2012.07.008
Lin TJ, Nelson LS, Tsai JL, et al. Common toxidromes of plant poisonings in Taiwan. Clin Toxicol (Phila) 2009;47:161-8.
DOI: https://doi.org/10.1080/15563650802077924
Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium - Theory, evidence and practice. Br J Clin Pharmacol 2016;81:516–24.
DOI: https://doi.org/10.1111/bcp.12839
Broderick ED, Metheny H, Crosby B. Anticholinergic Toxicity. 2021 Aug 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30521219.
Bross MH, Nash BT Jr, Carlton FB Jr. Heat emergencies. Am Fam Physician 1994;50:389-96.
Walker A, Delle Donne A, Douglas E, et al. Novel use of dexmedetomidine for the treatment of anticholinergic toxidrome. J Med Toxicol 2014;10:406-10.
DOI: https://doi.org/10.1007/s13181-014-0408-1
Moore PW, Rasimas JJ, Donovan JW. Physostigmine is the antidote for anticholinergic syndrome. J Med Toxicol 2015;11:159-60.
DOI: https://doi.org/10.1007/s13181-014-0442-z
Dart RC, Borron SW, Caravati EM, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med 2009;54:386–94 e1.
DOI: https://doi.org/10.1016/j.annemergmed.2009.01.023
Schneir AB, Offerman SR, Ly BT, et al. Complications of diagnostic physostigmine administration to emergency department patients. Ann Emerg Med 2003;42:14–9.
DOI: https://doi.org/10.1067/mem.2003.232
Derinoz O, Emeksiz HC. Use of physostigmine for cyclopentolate overdose in an infant. Pediatrics 2012;130:e703-5.
DOI: https://doi.org/10.1542/peds.2011-3038
Watkins JW, Schwarz ES, Arroyo-Plasencia AM, Mullins ME. The use of physostigmine by toxicologists in anticholinergic toxicity. J Med Toxicol 2015;11:179–84.
DOI: https://doi.org/10.1007/s13181-014-0452-x
Burns MJ, Linden CH, Graudins A, et al. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 2000;35:374–81.
DOI: https://doi.org/10.1016/S0196-0644(00)70057-6
Somani SM, Khalique A. Pharmacokinetics and pharmacodynamics of physostigmine in the rat after intravenous administration. Drug metabolism and disposition: the biological fate of chemicals 1987;15:627–33.
Walker WE, Levy RC, Hanenson IB. Physostigmine–its use and abuse. JACEP 1976;5:436–9.
DOI: https://doi.org/10.1016/S0361-1124(76)80253-5
Green R, Sitar DS, Tenenbein M. Effect of anticholinergic drugs on the efficacy of activated charcoal. J Toxicol Clin Toxicol 2004;42:267-72.
DOI: https://doi.org/10.1081/CLT-120037426
Isbister GK, Kumar VV. Indications for single-dose activated charcoal administration in acute overdose. Curr Opin Crit Care 2011;17:351-7.
DOI: https://doi.org/10.1097/MCC.0b013e328348bf59
Sharma AN, Hexdall AH, Chang EK, Nelson LS, Hoffman RS. Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate. Am J Emerg Med 2003;21:212-5.
DOI: https://doi.org/10.1016/S0735-6757(02)42248-6
Holger JS, Harris CR, Engebretsen KM. Physostigmine, sodium bicarbonate, or hypertonic saline to treat diphenhydramine toxicity. Vet Hum Toxicol 2002;44:1-4.
Jamshidi N, Dawson A. The hot patient: acute drug-induced hyperthermia. Aust Prescr 2019;42:24-28.
DOI: https://doi.org/10.18773/austprescr.2019.006
Catterson ML, Martin RL. Anticholinergic toxicity masquerading as neuroleptic malignant syndrome: a case report and review. Ann Clin Psychiatry 1994;6:267-9.
DOI: https://doi.org/10.3109/10401239409149014
Ista E, van Dijk M. We Can Not Compartmentalize Our Patients! Overlapping Symptoms of Iatrogenic Withdrawal Syndrome, Pediatric Delirium, and Anticholinergic Toxidrome. Pediatr Crit Care Med 2017;18:603-604.
DOI: https://doi.org/10.1097/PCC.0000000000001163
Agarwal P, Bansal S, Sharma A, Saini VK. Atropine poisoning mimicking septicemia. Ann Neurosci 2014;21:34-5.
DOI: https://doi.org/10.5214/ans.0972.7531.210111
How to Cite
Agosti, A., Bricchi, S., Rovati, F. ., Vancea Opris, M., Ponzi, D. G., Mariani, F., Morelli, N. ., Magnacavallo, A., Vercelli, A., & Poggiali, E. (2022). A sabbath in the emergency room or a case of anticholinergic toxicity?. Emergency Care Journal, 18(1). https://doi.org/10.4081/ecj.2022.10292
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
