1/7. Datura delirium.poisoning with tropine alkaloids from cultivated plants and pharmaceuticals is an uncommon cause of delirium and coma. We report a patient with a toxic delirium following ingestion of the tropine alkaloid-containing root of Datura innoxia. Thin-layer chromatography and gas chromatography/mass spectrometry confirmed the presence of atropine and scopolamine in samples of the ingested root. Routine clinical toxin screens may not include an assay for tropine alkaloids. A specific tropine alkaloid assay may provide supporting evidence. The clinical, electroencephalographic, and therapeutic aspects of anticholinergic poisoning are discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/7. poisoning by Coriaria myrtifolia Linnaeus: a new case report and review of the literature.Coriaria myrtifolia should be recognized as one of the most neurotoxic plants in western Mediterranean area. This shrub produces a toxin, coriamyrtin, that is present in high concentrations in the berries. Ingestion of few fruits similar to blackberries may induce digestive and neurological manifestations including seizures, coma and apnea. The authors present a new case report that took place in the French Catalonia: an 8 year-old boy developed vomiting and generalized recurrent convulsions after ingestion of C. myrtifolia berries. He needed repeated diazepam administrations and was managed in the hospital. He recovered after one day of benzodiazepine treatment. In order to evaluate the consequences of C. myrtifolia poisoning, 83 cases of the literature were analyzed: the cases occurred in three countries (spain, france and morocco); the mean delay of the symptom development was 150 min; the neurological disturbances were the most frequent signs and 11 patients died (6 children, 5 adults) mainly in old reports.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
3/7. A case of water hemlock poisoning.water hemlock is a ubiquitous plant that can be mistaken for a turnip as in the case reported. Oral ingestion causes an explosive illness consisting of nausea, vomiting, abdominal cramps, and grand mal seizures that can progress to cyanosis and death. In the reported case a 30-year old man was found semi-comatose some 75 minutes after ingesting a "turnip". The history revealed profuse emesis shortly after eating lunch that changed from bile to frank blood. There was a mean orthostatic blood pressure change of 30 torr, with an increase in the heart rate of 10%. neurologic examination revealed a lethargic patient. Following administration of 4 liters of Ringer's lactate the patient's blood pressure stabilized and with continued isotonic fluid maintenance he improved rapidly. This case indicates that appropriate management should be directed toward protecting the patient's airway from gastric aspiration, restoring the intravascular and extracellular volume deficit, and controlling cerebral edema.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/7. Identification of 5-hydroxyhexanoic acid in the urine of twin siblings with a Reye's-like syndrome associated with dicarboxylic aciduria and hypoglycaemia and with similarities to Jamaican vomiting sickness.Twin male infant siblings who presented in Harrow, UK, with a Reye's-like syndrome associated with profound hypoglycaemia, vomiting, diarrhoea, coma and death in one child, with dicarboxylic aciduria, and similarities to Jamacian vomiting sickness (hypoglycin toxicity) have been shown to excrete large amounts of a previously unrecorded urinary organic acid. This has been identified as 5-hydroxyhexanoic acid by gas chromatography mass spectrometry using a synthesized standard. Concentrations observed were 340 and 330 mg g-1 creatinine in the two patients. The metabolic precursor of the urinary acid is suggested to be hex-4-enoic acid, a probable chemical toxin closely related to the active organic acid metabolite of hypoglycin. The possibility of omega - 1 oxidation of hexanoic acid to 5-hydroxyhexanoic acid in these and other patients with dicarbocylic aciduris is also discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/7. plasma and urine concentrations of atropine after the ingestion of cooked deadly nightshade berries.BACKGROUND: adult intoxications due to ingestion of deadly nightshade berries is uncommon. case reports: Collective intoxication of eight persons occurred after accidental ingestion of ripened atropa belladonna berries. Three of the four adults displayed delirious states with visual hallucinations; one patient fell into a coma and required mechanical ventilation. Four children and one adult exhibited mild peripheral anticholinergic symptoms. Kinetic data were obtained on the three hospitalized adults. DISCUSSION: The optimal intensive care for such patients is discussed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/7. Plant poisonings in children.1. Plant poisonings comprise 5% of all hospitalizations due to poisonings in children and plant inquiries to Poison Information Centre consist about 28% of calls concerning children. 2. A search of 71 cases of hospitalization due to plants in a 5 year period obtained from two children's hospitals in Helsinki were reviewed and 105 plant inquiries concerning poisonings among children to the Poison Information Centre in a 6 month period were studied. 3. The most frequent plant poisonings involved lily-of-the-valley, dumb cane and cotoneaster plant. Only 11% of the cases treated in hospital were evaluated to be unequivocal poisonings. 4. Mezereon, snowberry, cotoneaster plant, honeysuckle, and woody nightshade caused the most serious symptoms. Symptoms in mezereon poisoning were increased saliva excretion, haematuria and diarrhoea in a 1.2-year-old girl. Snowberries caused a semicomatose state and difficulty in urination, cotoneaster caused severe stomach ache, honeysuckle abudant gastrointestinal symptoms and muscle cramps, and nightshade led to prolonged high fever and sweating. 5. It appears that almost all plant poisonings could be treated with medical charcoal. Gastric evacuation is seldom required.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/7. The dangers of jimson weed and its abuse by teenagers in the Kanawha Valley of west virginia.Jimson weed (datura stramonium, a member of the Belladonna alkyloid family) is a plant growing naturally in west virginia and has been used as a home remedy since colonial times. Due to its easy availability and strong anticholinergic properties, teens are using Jimson weed as a drug. Plant parts can be brewed as a tea or chewed, and seed pods, commonly known as "pods" or "thorn apples," can be eaten. Side effects from ingesting jimson weed include tachycardia, dry mouth, dilated pupils, blurred vision, ballucinations, confusion, combative behavior, and difficulty urinating. Severe toxicity has been associated with coma and seizures, although death is rare. Treatment consists of activated charcoal and gastric lavage. Esmolol or other beta-blocker may be indicated to reduce severe sinus tachycardia. seizures, severe hypertension, severe hallucinations, and life-threatening arrhythmias are indicators for the use of the anticholinesterase inhibitor, physostigmine. This article reviews the cases of nine teenagers who were treated in hospitals in the Kanawha Valley after ingesting jimson weed. We hope this article will help alert primary care physicians about the abuse of jimson weed and inform health officials about the need to educate teens about the dangers of this plant.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |