Tropane Alkaloid Poisoning Clinical Presentation

Updated: Sep 18, 2019
  • Author: Richard A Wagner, MD, PhD, FACEP, FAAEM; Chief Editor: Asim Tarabar, MD  more...
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Presentation

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 lon Datura stramonium (jimson weed). Note 4-5 inch long white flowers.© 2000 Richard Wagner
Datura stramonium flower. Note the trumpetlike sha Datura 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 Examination

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 for remembering the anticholinergic toxidrome.

Vital signs may include the following:

  • 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 findings include mydriasis and cycloplegia (almost always occur and may persist for days) and dry mucous membranes. Diminished bowel sounds and distention of urinary bladder may be present. Neurologic findings include the following:

  • Agitation
  • Confusion
  • Hallucinations
  • Seizures
  • Decreased muscle coordination
  • Paralysis
  • Respiratory depression
  • Coma (rare)
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