Datura and Brugmansia plants related antimuscarinic toxicity: an analysis of poisoning cases reported to the Taiwan poison control center.
Level 4 - case-series / case-control
Retrospective case series of poison control center records
PubMed 30522351 · doi:10.1080/15563650.2018.1513527
What was done
A retrospective case series analyzed 203 patients with Datura (n = 114) and Brugmansia suaveolens (n = 89) exposures reported to the Taiwan Poison Control Center between 1986 and 2015. Clinical records were abstracted to identify predictors of poisoning severity using logistic regression, and bivariate analysis evaluated the effectiveness of physostigmine.
What was found
Unsupervised medicinal use was the primary cause of poisoning (81.2%), while 2% occurred after prescription by Chinese medicine practitioners, and 0% involved recreational use. Frequent clinical features were mydriasis (53.2%), confusion (40%), tachycardia (35.5%), dry mouth (35.5%), dizziness (34%), dry skin (32.5%), and delirium (31%). Severe toxicity developed in 36% (73/203) of patients; no deaths occurred. Plant misidentification and ingestion of plant parts other than flowers were positively associated with severe poisoning. Physostigmine was given to 19.7% (40/203) of patients and was associated with earlier resolution of central nervous system toxicity without reported adverse events.
Why it matters
Unlike Western cohorts where anticholinergic plant exposures are largely recreational, poisonings in Taiwan stemmed primarily from unsupervised medicinal use. The findings support physostigmine as a safe and effective intervention to speed recovery from central anticholinergic toxicity.
Limits
This is a retrospective poison center registry study subject to reporting bias and incomplete follow-up. Plant identification and ingested doses were unconfirmed by laboratory testing, and physostigmine administration was observational and non-randomized.
Cited by
- supports High systemic doses of antimuscarinic medications commonly induce side effects such as dry mouth and tachycardia.