From the Guidelines
Dhatura poisoning treatment requires immediate medical attention, with a focus on supportive care, including airway management, hemodynamic support, and correction of critical vital sign and metabolic derangements, as emphasized in the 2023 American Heart Association guidelines 1. The primary goal is to prevent further absorption of the toxin and manage symptoms. Activated charcoal may be administered to prevent further absorption if the poisoning occurred recently. Physostigmine is the primary medication used to counteract the anticholinergic effects of dhatura. Some key aspects of treatment include:
- Supportive care with IV fluids to maintain hydration
- Benzodiazepines like diazepam to control seizures or agitation
- Cooling measures for hyperthermia
- Continuous monitoring of vital signs
- Respiratory support in severe cases Dhatura contains tropane alkaloids (atropine, scopolamine, and hyoscyamine) that block acetylcholine receptors, causing symptoms like confusion, hallucinations, rapid heartbeat, dry mouth, dilated pupils, and hyperthermia. The treatment aims to neutralize these effects and support body functions until the toxins are eliminated, as outlined in the 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning 1. Recovery typically takes 24-48 hours, though some symptoms may persist longer. Prevention of future exposure is crucial, as dhatura plants are common in many regions.
From the FDA Drug Label
PEDIATRIC DOSAGE Recommended dosage is 0.02 mg/kg; intramuscularly or by slow intravenous injection, no more than 0.5 mg per minute. If the toxic effects persist, and there is no sign of cholinergic effects, the dosage may be repeated at 5 to 10 minute intervals until a therapeutic effect is obtained or a maximum of 2 mg dosage is attained. IN ALL CASES OF POISONING, THE USUAL SUPPORTIVE MEASURES SHOULD BE UNDERTAKEN. The treatment for Dhatura poisoning may involve the use of physostigmine (IV) with a recommended dosage of 0.02 mg/kg. Key points to consider are:
- The dosage should be administered intramuscularly or by slow intravenous injection
- The maximum rate of administration is 0.5 mg per minute
- If toxic effects persist, the dosage may be repeated at 5 to 10 minute intervals until a therapeutic effect is obtained or a maximum of 2 mg is reached
- Supportive measures should be undertaken in all cases of poisoning 2
From the Research
Dhatura Poisoning Treatment
The treatment for Dhatura poisoning typically involves a combination of supportive care and specific interventions to manage the anticholinergic symptoms.
- Gastrointestinal decontamination, such as activated charcoal, may be administered to reduce the absorption of the toxic alkaloids 3.
- Supportive care, including external and internal cooling, sedation, and assisted-control mechanical ventilation, may be necessary to manage symptoms such as fever, tachycardia, and urinary retention 3.
- In life-threatening cases, physostigmine or neostigmine may be used to treat the anticholinergic syndrome 3, 4.
- Prevention of renal failure and treatment of rhabdomyolysis may also be necessary in severe cases 3.
Clinical Presentation and Diagnosis
The clinical presentation of Dhatura poisoning is similar to that of atropine poisoning, with symptoms including:
- Mydriasis
- Tachycardia
- Arrhythmias
- Agitation
- Seizures
- Coma 4, 5
- Diagnosis is primarily clinical, with early treatment being crucial to prevent serious illness or death 4.
Prognosis and Education
The prognosis for Dhatura poisoning is usually favorable, but it is essential to educate the public on the proper identification of locally available leafy vegetables that are fit for consumption to prevent accidental ingestion 6.
- Clinicians should also have a high index of suspicion in cases of family poisoning, even in the absence of a reliable history 6.