What is the treatment for Datura (Jimsonweed) ingestion in children?

Treatment of Datura (Jimsonweed) Ingestion in Children

The treatment of Datura stramonium (jimsonweed) ingestion in children requires immediate supportive care, gastrointestinal decontamination, and management of anticholinergic symptoms, with physostigmine reserved only for severe, life-threatening cases.

Initial Assessment and Management

• Recognize the clinical presentation of anticholinergic toxicity: hallucinations, agitation, mydriasis, tachycardia, hyperthermia, dry skin/mucous membranes, urinary retention, and altered mental status ranging from agitation to coma 1, 2
• Assess and secure airway, breathing, and circulation immediately in all cases 3
• Evaluate level of consciousness and need for respiratory support - intubation may be necessary for severely altered mental status 2, 3
• Monitor vital signs continuously, with special attention to temperature, heart rate, and respiratory status 4

Gastrointestinal Decontamination

• Administer activated charcoal as soon as possible if the patient presents within 1-2 hours of ingestion and has a protected airway 4, 3
• Consider repeated doses of activated charcoal as the anticholinergic effects can delay gastric emptying 3
• Gastric lavage may be considered in severe cases with recent ingestion (within 1 hour) and when the airway is protected 2

Symptom Management

• For agitation, hallucinations, and combativeness:

  • Administer benzodiazepines (e.g., lorazepam 0.05-0.15 mg/kg IV/IM) as first-line treatment 5, 2, 4
  • Provide a quiet, non-stimulating environment to reduce sensory input 4

• For hyperthermia:

  • Apply external cooling measures 3
  • Avoid antipyretics as they are ineffective for anticholinergic-induced hyperthermia 3

• For urinary retention:

  • Consider bladder catheterization if necessary 3

• For tachycardia and hypertension:

  • Monitor cardiac status with continuous ECG 2, 3
  • Treat only if hemodynamically significant 4

Specific Antidote: Physostigmine

• Physostigmine may be considered in severe, life-threatening anticholinergic toxicity when other measures have failed 6
• Pediatric dosage is 0.02 mg/kg by slow intravenous injection, no more than 0.5 mg per minute, with a maximum dose of 2 mg 6
• Dosing may be repeated at 5-10 minute intervals if toxic effects persist and no cholinergic effects are observed 6
• Caution: Physostigmine should only be used by clinicians experienced in its administration and with appropriate monitoring capabilities 6

Monitoring and Supportive Care

• Monitor for rhabdomyolysis, which can occur due to agitation, hyperthermia, and prolonged immobility 3
• Provide adequate hydration to prevent renal complications 3
• Monitor for QT prolongation or cardiac conduction abnormalities, which can occur with anticholinergic toxicity 3
• Continue observation until all anticholinergic symptoms have resolved, typically 24-48 hours 2, 3

Disposition

• Most children with mild to moderate intoxication can be managed with supportive care and observation 2, 4
• Severe cases require ICU admission, especially if respiratory support is needed or if physostigmine is administered 2, 3
• Consider psychiatric evaluation before discharge, particularly for adolescents, as ingestion may be intentional for hallucinogenic effects 4

Prevention

• Educate parents and children about the dangers of Datura plants 7
• Consider the possibility of underlying pica or geophagia in young children who ingest Datura, as this may increase risk 1

Pitfalls and Caveats

• Do not administer physostigmine routinely - reserve for severe, life-threatening cases unresponsive to supportive care 6
• Avoid antipsychotics like haloperidol if possible, as they may worsen anticholinergic effects and lower seizure threshold 4
• Remember that anticholinergic effects can last 24-48 hours or longer due to delayed gastric emptying and prolonged elimination 2, 4
• Consider Datura poisoning in any child presenting with unexplained anticholinergic symptoms, especially with visual hallucinations 4, 7