Jimson Weed Poisoning — A Case Report

Jimson weed, a plant best known among adolescents and young adults for its hallucinogenic properties, grows as a wild herb in the United States. Ingestion of jimson weed produces the toxidrome of anticholinergic intoxication. Understanding and recognizing the classic signs and symptoms of anticholinergic intoxication can help clinicians evaluate persons presenting with jimson weed poisoning. Introduction Ingestion of jimson weed (Datura stramonium) is fairly common and can lead to intoxication and to anticholinergic manifestations that are potentially dangerous. The plant is a wild herb that grows throughout the United States, usually matures between May and September, is accessible to almost anyone, and is particularly popular among adolescents curious about the plant’s hallucinogenic effects. Understanding the signs and symptoms of jimson weed toxicity can lead to early diagnosis and proper case management. Anticipatory counseling for teenagers and parents may also prevent experimentation and resultant harm. Case Report The mother of a 15-year-old boy brought him to the emergency department (ED) because of his bizarre behavior, including hallucinating. The mother had been advised by a neighbor that several neighborhood youths had been taken to nearby hospitals after ingesting wild flowers and then hallucinating. The patient’s mother had entered the patient’s room and found him shaking, mumbling, and trying to pick at nonexistent items. She noted several white flowers in his room and brought them to the ED. In the ED, the patient was restless, pacing incessantly, and shaking. He was awake, alert, and oriented to name but not to place or time. Vital signs included oral temperature 99.3F (37.4C), blood pressure 117/72 mmHg, heart rate 103 beats/min, and respiratory rate 24 breaths/min. Pupils were dilated to 8 mm, symmetric, and minimally reactive to light. Mucous membranes were dry, and bowel sounds were decreased. The extremities were warm to the touch but were not hot. Neurologic examination showed that the patient was confused and mumbling, cranial nerves were intact, and both motor strength and reflexes were within normal limits. During the examination, the patient reached into the air as if trying to catch a nonexistent object. Results of an emergent fingerstick blood glucose test, complete blood count, chemistry panel, and urinalysis were normal. Results of a toxicology screen were negative for alcohol, benzodiazepines, amphetamines, marijuana, tricyclic antidepressant agents, opiate agents, and phencyclidine. An electrocardiogram showed sinus tachycardia without other abnormality. Cranial structures appeared normal on computed tomography scans administered without contrast medium. On the basis of both the clinical presentation and a history of ingesting a wild plant, the ED physician suspected jimson weed intoxication, which was confirmed by comparing the mother’s plant specimen with a picture of jimson weed (obtained from the Internet). The patient denied any drug use but stated that his friends had given him a blended drink consisting of strawberries, a wild plant, and a small amount of alcohol. In the ED, the patient received several doses of lorazepam intravenously as treatment for agitation. He was admitted to the hospital for observation and for monitoring. The patient remained stable, and his mental status improved. At a subsequent interview, the patient admitted that he and his friends had consumed jimson weed deliberately: They had tried it for the first time after hearing that it was hallucinogenic. After 36 hours of observation, the patient was discharged from the hospital. Discussion Jimson weed is a member of the nightshade family. An earlier name for the plant was Jamestown weed, coined after intoxication from the plant was first recorded in Jamestown, Virginia, in 1676; the name was subsequently shortened to jimsonweed . The same plant is known also as thorn apple, angel’s trumpet, stinkweed, and green dragon. The plant has been used for centuries to treat asthma, diarrhea, intestinal cramps, and nocturia because of its anticholinergic effects, and its hallucinogenic effects were mentioned in Homer’s tale, The Odyssey. Jimson weed reaches a height of five feet and consists of large, jagged leaves and trumpet-shaped flowers, that may be white or purple. At maturity, the plant bears green fruit, each containing four compartments and holding as many as 100 seeds. Although all parts of the plant Kit Chan, MD, is currently a third-year resident in the Family Medicine residency at Kaiser Permanente, Fontana in Southern California. He grew up in California and graduated from the UCLA Medical School in 2000. E-mail: [email protected].