INTOXICATION AFTER INGESTION OF A DELETERIOUS PLANT 4th Department of Internal Medicine, Hippokration General Hospital of Thessaloniki Medical School of Aristotle University Soulaidopoulos S., Ligdi L., Sinakos E.

Case description An elderly couple (m: 86 f:82) were brought to the ER for acute onset of: Discount consciousness Hallucinations Excitation Delirium History: Consumption of the foliage of the toxic plant among with other greens Medical history m : AF, Coronary Artery Disease f : Hypertension Clinical condition : Both of them disoriented, agitated, making purposeless movements with irrepressible speech and hallucinations pupils: dilated not responding to light Abdomen: urinary retention, lessening intestinal peristalsis

Treatment Communication with the poison centre for instructions Supportive treatment - gastric decontamination with nasogastric lavage - administration of activated charcoal via a gastric tube - Benzodiazepines were administered to control the agitation and hallucinations (diazepam iv 5mg x 2 daily) Both of the patient stayed under monitoring for the first 24 hours. There was a gradual improvement at their level of conscousness. They were discharged home after four days of hospitalization Physostigmine - reversible acetylcholinesterase inhibitor capable of directly antagonizing CNS manifestations of anticholinergic toxicity - side effects : salivation, lacrimation, urination, defecation, emesis, life-threatening cholinergic crisis ( asystole, respiratory depression, seizures)

Causes of disorders of consciousness Traumatic brain injury (falls, traffic accidents, violent assaults) Non- traumatic brain injury - strokes - heart attack - systemic and brain infections (meningitis, encephalitis) - drug overdoses - poisoning - types of suffocation (almost drowning, smoke inhalation) - cerebral hemorrhage (ruptured aneurysm) - epilepsy - metabolic disorders - vertigo Progressive brain damage ( Parkinson’s & Alzheimer’s disease, brain tumors) Psychiatric condition (conversion disorder)

Datura Stramonium Member of the Solanaceae family Jimson weed, Devil's snare herbal medicine for asthma symptoms powerful hallucinogen and deliriant dangerous levels of the tropane alkaloids atropine, hyoscyamine and scopolamine Datura intoxication - typically produces delirium, hyperthermia, tachycardia, bizarre behavior - severe mydriasis with resultant painful photophobiaronounced - amnesia - onset of symptoms around 30 to 60 minutes after ingesting the herb - the symptoms last from 24 to 48 hours

Take home messages Always consider poisoning when there are same clinical manifestation from the CNS at people living together Datura Stramonium intoxication should be considered in cases of patients presenting with unexplained peripheral and central anticholinergic symptoms including delirium, agitation and seizures