Datura (dhatura, atropine , scopolamine, thorn apple , jimson weed) poisoningpoisoning

datura poisoning

1. Datura poisoning ( Deliriant Poision ) By Dr. Muhammad Zeeshan Dept. of Forensic Medicine , BMC, Bannu

2. Datura poisoning ( Deliriant Poision ) By Dr. Muhammad Zeeshan Marwat Dept. of Forensic Medicine , BMC, Bannu

3. Key points Introduction Mechanism of action Signs and symptoms (toxicity) Fetal and Lethal doses Diagnosis Treatment Postmortem Appearance Medicolegal Aspects Datura poisoning 3

4. Introduction Datura is a genus of nine species of poisonous Vespertine flowering plants belonging to the family Solanaceae of kingdom Plantae. The leaves are alternate, with a lobed or toothed margin. The flowers are erect or spreading trumpet-shaped ,colors vary from white to yellow, pink, and pale purple. The fruit is a spiny capsule giving the name thorn apple to the plant,splitting open when ripe to release the numerous seeds. An average size fruit contains 450-500 seeds and weighs 8 grams. Datura poisoning 4

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7. Introduction (cont’d) Datura poisoning 7 Synonyms : devil's trumpets , moonflower , jimson weed , devil's weed, hell's bells and thorn-apple. Traditionally used for skin disorder, ear pain, cough ,asthma, arthritis, antispasmodics and as adjunctive with some drugs i.e cannabis to boost its effects. There are two varieties of datura i.e Datura alba ( safad datura ) Datura nigra (kala datura )

8. Active Principles All parts of the plants are toxic but fruits and seeds are more, and datura has a long history of use for causing delirious states and death. Active Principle: Laevohyoscyamine Hyoscine or scopolamine Traces of atropine The all act mainly on CNS each having its own individual action. Datura poisoning 8

9. Mechanism of action Alkaloids of datura interact with and inhibit all muscarinic receptor in the body which lead to blockage of action of neurotransmitter Ach at muscarinic receptor and hence block parasympathetic system. High dose may also block nicotinic receptor at autonomic ganglia and NMJ. Datura poisoning 9

10. Signs and Symptoms Datura poisoning 10 The alkaloids of datura stimulate higher centers of brain and then motor centers. They inhibits secretion of sweat and saliva, dilate the cutaneous blood vessels, dilate the pupil and stimulate heat regulating centre . CNS effects: The initial stimulation is followed by depression and paralysis of vital centres in medulla. The mind is affected first and he is subjected to auditory and visual hallucination. He appears to grasp an imaginary objects , picks at clothes and tries to pulls imaginary threads from tips of fingers.

11. Signs and Symptoms (cont’d) Signs and symptoms can be described as Dry as bone (decrease salivation,dry throat and mouth) blind as bat ( pupils are dilated and non reactive to light) hot as hare (skin is hot and dry) mad as hatter ( altered mental status) red as beet (cutaneous vasodilation and flushed face) Datura poisoning 11

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13. Signs and Symptoms (cont’d) Important symptoms can be summerized as 9Ds Dryness of mouth, throat Difficulty in talking Dysphagia Dilatation of cutaneous blood vessels Dilatation of Pupils Dry hot skin Drunken gait Delirium Drowsiness Datura poisoning 13

14. Fatal Doses and Fetal Period Fatal Dose: 100 to 125 seeds. The lethal dose for alkaloid is about 60mg for adult and 4 mg for children. Fatal Period: death usually occur within 24 hours Datura poisoning 14

15. Diagnosis History Circumstantial evidance Physical examination Investigation i.e toxicology screen, ECG abnormalities Datura poisoning 15

16. Treatment Decontamination i.e stomach wash with KMnO4 or tannic acid AND purgatives Physiological antidote i.e physostigmine (1-4mg and is repeated at intervals of 1-2 hours if necessary ) OR Neostigmine (2.5mg I.v every 3 hours) . Moistening of tongue and change in size of pupils guides towards good prognosis. In non fatal case recovery takes a day or two , the effect on pupil being last to disappear Datura poisoning 16

17. Postmortem Appearances Findings are those of Asphyxia Datura seeds may be found in stomach Congestion of GI Datura seeds resist putrefaction Datura poisoning 17

18. Medicolegal Importance For Crime ie robbery, kidnapping and rape.Children can easily be kidnapped by giving them candy or toffee mixed with datura . Accidental cases occur when children and adults eats the raw fruit or seeds mistaking them for edible fruits or capsucum seeds. Homicide Sucide Abortificant Datura poisoning 18

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