Not Your Everyday Anisocoria: Angel’s Trumpet Ocular Toxicity

Firestone, Daniel; Sloane, Christian

doi:10.1016/j.jemermed.2007.02.046

Cited by 35 publications

(17 citation statements)

References 5 publications

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“…The authors performed experimental studies on dogs, which showed that contact with any part of D. stramonium could induce this condition. The same condition, a syndrome called anisocoria (an unilateral mydriasis) is also know in human patients that have been in contact with plant material from (ornamental) Datura species (Firestone and Sloane, 2007) indicating a high rate of absorption of tropane alkaloids through mucosal membranes.…”

Section: Dogsmentioning

confidence: 81%

Tropane alkaloids (from Datura sp.) as undesirable substances in animal feed - Scientific Opinion of the Panel on Contaminants in the Food Chain

2008

EFSA Journal

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SUMMARYThe term tropane alkaloids refers to a group of more than 200 compounds best known for their occurrence in the family Solanaceae comprising over 100 genera and 3000 plant species. They have in common a two-ringed structure characterized by a pyrrolidine and a piperidine ring sharing a single nitrogen atom and two carbons atoms. The nitrogen atom at the end of the molecule, which characterizes the compounds as alkaloids, is in this group characteristically methylated. The most important natural tropane alkaloids are (-)-hyoscyamine and (-)-scopolamine (also known as hyoscine). High concentrations of these alkaloids have been found particularly in Datura stramonium and Datura ferox, as well as in Datura innoxia. The pattern of tropane alkaloids differs significantly and in Datura stramonium (also known as thorn apple or Jimson weed) hyoscyamine prevails in most parts of the plant, whereas in Datura ferox scopolamine is the major alkaloid Tropane alkaloids as undesirable substances in animal feedThe EFSA Journal (2008) 691, 2-55 produced. Datura plants are toxic for animals if ingested in larger amounts. Their seeds, which contain significant amounts of hyoscyamine and scopolamine, can be found as botanical impurities in feed materials, particularly in soybean and linseed products.Very little information on the actual contamination of feed materials is available, and previous reports on adverse health effects in animals refer in most cases to accidental intoxications following the consumption of Datura plants rather than to the contamination of linseed and sobean contaning feed materials. Hence no conclusive exposure assessment could be presented for farm animals.Overall, pigs have been shown to be among the most sensitive species to Datura poisoning. A worst case exposure estimate indicated that adverse pharmacological effects in pigs following exposure to Datura ferox seeds, mainly containing scopolamine, can not be entirely excluded at the current statutory limits of 3000 mg/kg feed. However, the limited data also suggested that it is not likely that the presence of Datura stramonium impurities in animals feed up to the current statutory level of 1000 mg/kg would present a risk to animal health.The mechanism of action of tropane alkaloids relates to their competitive antagonism at muscarinic acetylcholine receptors, preventing the binding of acetylcholine. According to the specificity and selectivity of muscarinergic acetylcholine receptors in different organs, the functions of smooth muscles and exocrine gland cells, as well as the heart rate, respiration and functions in the central nervous system are modulated. Certain tropanes such as atropine (the racemic mixture of (-)-and (+)hyoscyamine) as well as scopolamine (mainly as butylscopolamine bromide) are used in human and veterinary therapy for a variety of related indications. Reports of poisoning of livestock and experimental feeding studies describe as most common symptoms associated with tropane alkaloids exposure dryness of the mucosa in the uppe...

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Section: Dogsmentioning

confidence: 81%

Tropane alkaloids (from Datura sp.) as undesirable substances in animal feed - Scientific Opinion of the Panel on Contaminants in the Food Chain

2008

EFSA Journal

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“…Use of "folk" remedies must specifically be inquired about, as patients seldom reveal the use of alternative treatments to their physicians (46). A detailed history and directed examination of the pupil may reveal a pharmacologic etiology for mydriasis, in selected cases reversible by instillation of pilocarpine, thus potentially sparing the patient an extensive work-up and brain imaging (1,6,42). …”

Section: Resultsmentioning

confidence: 99%

“…Toxic plants causing pupillary dilatation contain naturally occurring alkaloids such as atropine and scopolamine (36). These include blue nightshade, jimson weed, moonflower (Ipomoea alba), and the ornamental plant Angel's trumpet (Datura suaveolens) (37)(38)(39)(40)(41)(42)(43).…”

Section: Other Causes Of An Abnormally Dilatated Pupilmentioning

confidence: 99%

Unilateral Mydriasis Due to Hemorrhoidal Ointment

Polomsky

Smereck

2012

The Journal of Emergency Medicine

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“…For centuries, it has been known to produce hallucinogenic effects; however, intoxication can lead to potentially dangerous anticholinergic manifestations. 10 Importantly, the antidote physostigmine was only used in a few cases, despite the fact that studies in adults have demonstrated that repeated doses of physostigmine reverse anticholinergic features without side effects. Torbus Table 1 summarizes pediatric patients (up to 17 years old) with Jimsonweed poisoning reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Use of Physostigmine for Hallucinogenic Plant Poisoning in a Teenager

Glatstein

Alabdulrazzaq

García-Bournissen

et al. 2012

American Journal of Therapeutics

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The objective of this study was to utilize a case report to review the use of physostigmine for jimsonweed intoxication. A 15-year-old girl was found at school hallucinating and incoherent. Upon presentation to the emergency department, she was found to be tachycardic and confused with dilated pupils and dry, flushed, hot skin. She was admitted to our institution. Hallucinations and symptoms resolved after the use of physostigmine. She subsequently admitted to ingesting 'moonflower seeds,' which are derived from Jimsonweed (Datura stramonium). She was discharged when she got well. Jimsonweed is known to contain high concentrations of anticholinergic substances; hence, ingestion can result in the anticholinergic toxidrome. Signs and symptoms include hallucinations, tachycardia, dilated pupils, and disorientation. In our patient, the use of the physostigmine as an antidote resulted in a favorable outcome without any complications. Ingestion of the Datura species can result in severe toxicity. Each plant varies in the concentrations of alkaloid substances. For this reason, it is very important for individuals to become educated on the toxicities and potential risks associated with recreational use of these plants. The use of physostigmine can help in both the diagnosis and management of patients intoxicated with these substances.

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Not Your Everyday Anisocoria: Angel’s Trumpet Ocular Toxicity

Cited by 35 publications

References 5 publications

Tropane alkaloids (from Datura sp.) as undesirable substances in animal feed - Scientific Opinion of the Panel on Contaminants in the Food Chain

Tropane alkaloids (from Datura sp.) as undesirable substances in animal feed - Scientific Opinion of the Panel on Contaminants in the Food Chain

Unilateral Mydriasis Due to Hemorrhoidal Ointment

Use of Physostigmine for Hallucinogenic Plant Poisoning in a Teenager

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