Datura delirium

Alkaloids of the Genus Datura: Review of a Rich Resource for Natural Product Discovery

The genus Datura (Solanaceae) contains nine species of medicinal plants that have held both curative utility and cultural significance throughout history. This genus’ particular bioactivity results from the enormous diversity of alkaloids it contains, making it a valuable study organism for many disciplines. Although Datura contains mostly tropane alkaloids (such as hyoscyamine and scopolamine), indole, beta-carboline, and pyrrolidine alkaloids have also been identified. The tools available to explore specialized metabolism in plants have undergone remarkable advances over the past couple of decades and provide renewed opportunities for discoveries of new compounds and the genetic basis for their biosynthesis. This review provides a comprehensive overview of studies on the alkaloids of Datura that focuses on three questions: How do we find and identify alkaloids? Where do alkaloids come from? What factors affect their presence and abundance? We also address pitfalls and relevant questions applicable to natural products and metabolomics researchers. With both careful perspectives and new advances in instrumentation, the pace of alkaloid discovery—from not just Datura—has the potential to accelerate dramatically in the near future.

Epidemic of poisoning caused by scopolamine disguised as Rohypnol tablets

OBJECTIVE

An epidemic of scopolamine poisonings occurred in Oslo in 2008 among users of illicit drugs, caused by fake Rohypnol pills. The clinical features, diagnostic process, and handling of the epidemic are presented.

METHODS

Suspected cases of scopolamine poisoning were extracted by reviewing registration forms from an ongoing prospective clinical study of acute poisonings in Oslo. Medical records of extracted contacts were examined and cases included according to specified clinical criteria.

RESULTS

Forty-four cases of probable scopolamine poisoning were registered. Main clinical features were mydriasis, visual hallucinations, plucking behavior, agitation, and coma. No clinical diagnosis of anticholinergic syndrome was made prior to forensic analysis of the tablets, the most frequent diagnosis up to this point being unspecified drug-induced psychosis. Later in the epidemic, scopolamine poisoning became the dominating diagnosis. Ten patients were admitted to psychiatric hospitals, the rest recovered in medical units, or left health care against medical advice.

DISCUSSION

Scopolamine poisonings are rare, but the resulting anticholinergic syndrome is well described. The syndrome was not recognized until the forensic analysis result strikingly changed how the patients were diagnosed and handled. A unique aspect of this epidemic was the intoxicating agent being scopolamine-containing tablets looking like Rohypnol, sold and used under the impression of being the latter.

CONCLUSION

Recognizing the anticholinergic syndrome is important to provide proper treatment. Forensic analysis was the key to correct diagnosis in this outbreak, demonstrating its importance in verifying an epidemic of poisoning by fake drugs.

Plant poisoning

Each year over 100,000 exposures to toxic plants are reported to poison centers throughout the United States. Most of these exposures are of minimal toxicity largely because of the fact that they involve pediatric ingestions, which are of low quantity. The more serious poisonings usually involve adults who have either mistaken a plant as edible or have deliberately ingested the plant to derive perceived medicinal or toxic properties. The plants within this manuscript have been chosen because they have been documented to cause fatalities or account for emergency medicine visits. In this discussion, plants are grouped by their toxins rather than on the basis of their taxonomy.

Coma as a presenting sign of Datura stramonium seed tea poisoning

Datura stramonium is a hallucinogenic plant that causes serious poisoning. Consumption of any part of the plant may result in a severe anticholinergic reaction that may lead to toxicity and occasionally cause diagnostic difficulties. We report two patients with coma as a presenting sign of intoxication following intentional Datura seed tea ingestion and we review the leading clues for its diagnosis and treatment.

Distribution of hyoscyamine and scopolamine in Datura stramonium

The production of hyoscyamine and scopolamine in Datura stramonium has been investigated in the different plant parts, at different stages of their life cycle. Maximum contents were found in the stems and leaves of young plants, hyoscyamine being always the predominant component.

Biological neurotoxins

The authors divide biological toxins into animal, plant, and bacterial classes and discuss each within a context of demographic, clinical and research examples. Advances in our knowledge are highlighted, and the authors relate the implications of this knowledge to target-specific neurologic involvement.

Use of herbal medicines among consultation-liaison populations. A review of current information regarding risks, interactions, and efficacy

Consultation-liaison psychiatrists evaluate a wide variety of patients who are often disillusioned with conventional medical care and are seeking to gain some measure of control over their illness. With the growing popularity of alternative health care practices, consultation-liaison psychiatrists must learn more about the implications of herbal medicine usage. This review provides an overview of herbal medicines, a vital component of the alternative medicine movement.

Life-threatening plant poisoning

Each year over 100,000 exposures to toxic plants are reported to poison control centers around the country. This article focuses on the more toxic plant exposures which may result in critical care admissions. The various plants are identified and described. Their mechanism of toxicity, clinical presentation of exposure and a management strategy for the critical care physician are discussed. Resources for further information are also listed.

[Datura stramonium poisoning: the diagnosis is clinical, treatment is symptomatic]

Datura stramonium is a hallucinogenic plant found in urban or rural areas. It contains three main toxic alkaloids: atropine, scopolamine, and hyosciamine. Consumption of any part of the plant can result in severe anticholinergic toxicity. Clinical symptoms are those seen in atropine poisoning, particularly hallucinations and mydriasis. Prognostic is good in this study. Patients always require hospitalisation because of agitated behavior. Symptomatic treatment is efficient. Clinicians should be aware of the potential abuse of botanicals such as jimson weed to avoid excessive investigations.