There are several species of plants that contain tropane alkaloids consisting of atropine, scopolamine, and hyoscyamine compounds. Given the effect on the pupils with mydriasis, these are known as the belladonna (beautiful woman) alkaloids. Jimson weed species (Datura spp.) are the most well-known plants that contain these alkaloids. Ingestion may occur through the drinking of tea made from the leaves or flowers of the plant or from eating the plant’s seeds or leaves. Poisoned victims demonstrate an anticholinergic toxidrome resulting from the antimuscarinic receptor antagonistic effects of atropine and scopolamine. Patients may exhibit altered mental status, xerostomia, xeroderma, xerophthalmia, blurred vision, mydriasis, tachycardia, decreased bowel and bladder motility, and hyperthermia. Occasional presentations of unilateral mydriasis occur from topical exposure of the alkaloids (usually by touching the plant and then the eye).
Management and Disposition
Treatment initially consists of assessing the ABCs (airway, breathing, circulation) and stabilization measures. Hypotension resulting from tropane alkaloid ingestion usually responds to fluid boluses. Vasopressor agents are rarely necessary. Whole-bowel irrigation is contraindicated with intestinal ileus and must be considered with great caution due to decreased bowel motility. Physostigmine is a reversal agent, but may be better used as a diagnostic agent after consultation with the poison center. Severe agitation and psychosis may be treated with benzodiazepines and carefully administered, properly dosed physostigmine.
Jimsonweed. Jimsonweed seed pod with dried seeds. (Photo contributor: Matthew D. Sztajnkrycer, MD, PhD.)
Jimsonweed-Induced Xerostomia. A severe case of xerostomia from the antimuscarinic effects of Jimsonweed ingestion. Note the associated flushing of the patient’s cheek. (Photo contributor: R. Jason Thurman, MD.)
Angel’s Trumpet. Plants from the genus Brugmansia are cultivated for their beautiful pendulous flowers. Occasionally the leaves are brewed as a tea for intentional ingestion of the belladonna alkaloids. (Photo contributor: Saralyn R. Williams, MD.)
Administering 1% pilocarpine eye drops does not reverse anticholinergic mydriasis.
Jimsonweed toxicity should be considered in the differential diagnosis of children and adolescents presenting with acute altered mental status, especially when accompanied by signs of anticholinergic toxicity after eating seeds.