Effects of Datura (Jimsonweed) Ingestion
Datura ingestion causes severe anticholinergic toxicity that can lead to delirium, hallucinations, tachycardia, hyperthermia, and potentially death if not properly managed. 1, 2
Clinical Manifestations of Datura Toxicity
Anticholinergic Effects
- Neurological: confusion, delirium, hallucinations, agitation, amnesia, seizures, and coma 2, 3
- Cardiovascular: tachycardia, arrhythmias (including right bundle branch block), hypertension 2, 3
- Ophthalmological: mydriasis (dilated pupils), blurred vision, difficulty with visual accommodation 4, 3
- Gastrointestinal: dry mouth, nausea, vomiting 3
- Genitourinary: urinary retention requiring catheterization 2, 3
- Dermatological: flushed skin, hyperthermia 3
- Respiratory: respiratory depression (in severe cases) 2
Onset and Duration
- Effects typically begin 15-30 minutes after ingestion 3
- Symptoms can persist for 24-48 hours, with some effects (like amnesia) potentially lasting months 4
- Visual accommodation difficulties may persist for days after acute intoxication 4
Medical Complications and Risks
Severe Complications
- Respiratory depression requiring intubation 2
- Rhabdomyolysis with risk of acute kidney injury 2
- Hyperthermia 3
- Urinary tract infections secondary to retention 3
- Death (in severe untreated cases) 5
High-Risk Populations
- Adolescents and young adults seeking hallucinogenic effects are particularly vulnerable 4
- Accidental ingestion can occur when the plant is mistaken for edible vegetables 3
- Intentional ingestion for recreational purposes is common among teenagers 4
Management of Datura Poisoning
Immediate Interventions
- Airway management and intubation if necessary for respiratory depression or coma 2
- Gastrointestinal decontamination with activated charcoal (multiple doses may be required) 2, 5
- External and internal cooling for hyperthermia 2
- Intravenous fluids for supportive care 3
Pharmacological Treatment
- Physostigmine (anticholinesterase) for severe cases with life-threatening symptoms 2, 5
- Neostigmine infusion may be used to counteract anticholinergic effects 2
- Benzodiazepines may be needed for agitation or seizures 5
Monitoring Requirements
- Cardiac monitoring for arrhythmias 2
- Temperature monitoring for hyperthermia 3
- Renal function monitoring if rhabdomyolysis is present 2
- Neurological status assessment 2
Prevention and Public Health Considerations
Education and Awareness
- Increasing awareness about the dangers of Datura among adolescents and young adults is crucial 4
- Healthcare professionals should be familiar with the clinical presentation of anticholinergic toxicity 1
- Patients typically do not repeat ingestion due to unpleasant experiences 4
Harm Reduction
- If recreational use is anticipated, recommendations include having a non-user present, avoiding mixing with other substances, and seeking help at first signs of intoxication 4
- Early recognition and treatment significantly improve outcomes 5
Clinical Pitfalls and Caveats
- Datura poisoning can mimic other conditions with anticholinergic features 5
- Standard drug screening panels do not typically detect Datura alkaloids 1
- Diagnosis is primarily clinical based on symptoms and history of ingestion 4
- The mnemonic "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter" describes the classic anticholinergic toxidrome seen in Datura poisoning 5
- Delayed presentation may result in more severe outcomes due to prolonged toxicity 2