Tropane Alkaloid Poisoning Clinical Presentation

  • Author: Richard A Wagner, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: May 27, 2011
 

History

As in any patient presenting with an acute change in mental status or suspected poisoning, attempt to obtain the following information:

  • Complete past medical history
  • Medication history
  • Precise description or sample of suspected toxicant(s)
  • Route of administration, amount ingested, time since ingestion, and reason for ingestion
  • Co-ingestants and use of alcohol or other street drugs

Initial signs and symptoms may include the following:

  • Dry mucous membranes and skin
  • Dysphagia and dysarthria
  • Photophobia
  • Blurred vision
  • Tachycardia
  • Urinary retention

Initial signs and symptoms may be followed by hyperthermia, confusion, agitation, combativeness, seizures, coma, and death.

Amnesia regarding events following ingestion of tropane alkaloids is common.

Identification of ingested plants can be diagnostic of tropane alkaloid poisoning.

Datura species, the most commonly encountered plants containing tropane alkaloids, are 3-5 foot annuals with coarse-toothed leaves.

Trumpet-shaped flowers are 3-5 inches in length, with white-pale-violet colored petals (see the images below).

Datura stramonium (jimson weed). Note 4-5 inch lonDatura stramonium (jimson weed). Note 4-5 inch long white flowers.© 2000 Richard Wagner Datura stramonium flower. Note the trumpetlike shaDatura stramonium flower. Note the trumpetlike shape.© 2000 Richard Wagner

Most important for taxonomic identification are spiny, round, chambered seed pods (see the image below).

Datura stramonium (close-up of unripe seed pods). Datura stramonium (close-up of unripe seed pods). Note spiny appearance of pods.© 2000 Richard Wagner
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Physical

The mnemonic "red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare" is useful to remember the anticholinergic toxidrome.

Vital signs

  • Tachycardia and tachypnea
  • Hyperpyrexia (in about 20% of cases)
  • Inconsistent hypertension and hypotension, respiratory depression (rare)
  • Warm dry skin (may be flushed)

Head, ears, eyes, nose, and throat

  • Mydriasis and cycloplegia (almost always occur and may persist for days)
  • Dry mucous membranes

Abdomen

  • Diminished bowel sounds
  • Distention of urinary bladder

Neurologic

  • Agitation, confusion, and hallucinations
  • Seizures, decreased muscle coordination, paralysis, respiratory depression, and coma (rare)
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Contributor Information and Disclosures
Author

Richard A Wagner, MD  PhD, FACEP, Staff Physician, EmCare, Inc.

Richard A Wagner, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Samuel M Keim, MD  Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael Hodgman, MD  Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare

Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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Datura stramonium (jimson weed). Note 4-5 inch long white flowers.© 2000 Richard Wagner
Datura stramonium flower. Note the trumpetlike shape.© 2000 Richard Wagner
Datura stramonium (close-up of unripe seed pods). Note spiny appearance of pods.© 2000 Richard Wagner
Datura stramonium is the plant shown. © 2000 Richard Wagner
The plant shown is foxglove (Digitalis purpura), which contains cardiac glycosides, not tropane alkaloids. © 2000 Richard Wagner
 
 
 
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