“I Shouldn’t Have Had Dessert…” A Moonflower Seed Ingestion

A 60-year-old man had just enjoyed a summer meal that included hamburgers, fruit, and lettuce salad. He finished it off with some ice cream, and to make it healthier he threw on it a handful of seeds from the cupboard that he understood to be flax seeds. What he had eaten instead was a handful of Datura inoxia, or Moonflower seeds (Figure 1). Within 30 minutes he felt “drugged,” and shortly thereafter his wife and neighbor found him upstairs in front of his closet naked and holding a belt. He was “flushed in the face” and incoherent. They summoned medics who brought the man to the emergency department (ED). In the ED his Glasgow coma score was 7, he was tachycardic and febrile, his skin was flushed and dry, and he had no discernible bowel sounds. He was intubated for airway protection and admitted to the intensive care unit. After 18 hours of supportive care he was extubated and discharged uneventfully later that day. D. inoxia is not to be confused with Ipomoea muricata (purple moonflower) and Ipomoea alba (white moonflower).1 An ornamental plant with large white flowers, is a member of the Datura genus that also includes Datura stramonium (Jimson Weed).2 The plants in this genus contain toxic compounds in the form of the alkaloids atropine, scopolamine, and hyoscyamine.1 The entire D. inoxia plant is toxic, containing primarily scopolamine; in fact, it contains the largest amount of scopolamine of any plant.1 The seeds actually contain less scopolamine per gram than the rest of the plant. Ingestion of this substance causes antimuscarinic effects at low doses and both antimuscarinic and antinicotinic effects at high doses. These effects result in the anticholinergic toxidrome, as seen in this case.