Jimson weed seed dose

Datura

Datura is highly unpredictable and its use is strongly linked to psychosis, severe injury, and death. Please see this section for more details.

Summary sheet: Datura
Datura

WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section.

⇣ Oral
Dosage
Duration
Total 8 – 18 hours
Onset 20 – 120 minutes
Come up 60 – 120 minutes
Peak 5 – 12 hours
Offset 2 – 3 hours
After effects 6 – 24 hours

DISCLAIMER: PW’s dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy.

Datura (also known as devil’s trumpet, moonflower, jimsonweed, devil’s weed, hell’s bells, thorn-apple, and many others) is a genus of nine species of poisonous flowering plants belonging to the family Solanaceae. Daturas are known as powerful and dangerous deliriants, used for shamanic and medical purposes, as well as poisons. They contain the potent anticholinergic substances scopolamine, hyoscyamine, and atropine primarily in their seeds and flowers. [1]

Datura’s precise and natural distribution seem to be throughout most of the temperate and tropical regions of the globe, owing to its extensive cultivation and naturalization. The two most well-known species are Datura inoxia and Datura stramonium. Both have been used in a shamanic context for religious purposes on most continents since before recorded history throughout the ancient Americas, Europe, and India. [ citation needed ]

The toxicity of datura can be highly variable. There can easily be a 5:1 variation in toxins from plant to plant, and a given plant’s toxicity depends on its age, where it is growing, and local weather conditions. [ dubious – discuss ] These wide variations make datura exceptionally hazardous to use as a substance. An overdose of datura can occur from ingestion of as little as one half teaspoon of seeds. [1]

Contents

Chemistry

The principal psychoactive constituents of all datura plants are the tropane alkaloids scopolamine, hyoscyamine, and atropine. These constituents are structurally analogous compounds.

These tropane alkaloids contain a substituted tropane ring, a seven-membered ring with an N-methylated nitrogen bridge between R1 and R5. Scopolamine additionally has an oxygen bonded to R6 and R7 of this bicyclic structure to form a three membered oxirane ring. They also contain a propionic acid chain, CH3CH2COOH, which is substituted at R2 with an aromatic phenyl ring and at R3 with a hydroxyl group OH-. The propionic acid chain is linked at R1 through an oxygen atom to R3 of the substituted tropane ring to form an ether.

These compounds are secondary metabolites synthesized naturally by various plants. The ratio of these compounds in datura plants varies greatly depending on location, growing conditions, etc. The datura genus contains other chemical constituents, but limited research has been done on their properties. Scopolamine, hyoscyamine, and atropine have a stereocenter at R2 of their propionic chain. Hyoscyamine is the levorotorary enantiomer of atropine.

Pharmacology

The alkaloids within datura exert their effects by acting as competitive antagonists at muscarinic acetylcholine receptors, primarily muscarinic acetylcholine receptors M1 and M2. Although the precise mechanism is not understood, it’s this inhibition of acetylcholine which leads to delirium, sedation and intensely realistic hallucinations alongside of extremely uncomfortable and dysphoric physical side effects.

All parts of Datura plants contain dangerous levels of the tropane alkaloids atropine, hyoscyamine, and scopolamine, which are classified as deliriants, or anticholinergics. The risk of fatal overdose is high among uninformed users, and many hospitalizations occur among recreational users who ingest the plant for its psychoactive effects. Deliberate or inadvertent poisoning resulting from smoking jimsonweed and other related species has been reported.

Cultivation

Datura stramonium prefers rich, calcareous soil. Adding nitrogen fertilizer to the soil increases the concentration of alkaloids present in the plant. D. stramonium can be grown from seed, which is sown with several feet between plants. It is sensitive to frost, so should be sheltered during cold weather. The plant is harvested when the fruits are ripe, but still green. To harvest, the entire plant is cut down, the leaves are stripped from the plant, and everything is left to dry. When the fruits begin to burst open, the seeds are harvested.

Subjective effects

Disclaimer: The effects listed below cite the Subjective Effect Index (SEI), an open research literature based on anecdotal user reports and the personal analyses of PsychonautWiki contributors. As a result, they should be viewed with a healthy degree of skepticism.

It is also worth noting that these effects will not necessarily occur in a predictable or reliable manner, although higher doses are more liable to induce the full spectrum of effects. Likewise, adverse effects become increasingly likely with higher doses and may include addiction, severe injury, or death ☠.

Physical effects

  • The physical effects of datura can be described as extremely unpleasant and distressing to the extent that they make enjoying the experience impossible especially at common to heavy dosages.
    • Sedation or Stimulation
    • Perception of bodily heaviness – The first noticeable sensation is having an extremely heavy body as if the gravity one is subject to has increased exponentially. This makes it extremely difficult and uncomfortable to move.
    • Spontaneous bodily sensations – Users commonly report all-encompassing, sharp and extremely painful jolts of electricity that spontaneously manifest themselves in a similar rhythm to hiccups.
    • Abnormal heartbeat [citation needed]
    • Bronchodilation
    • Constipation
    • Dehydration
    • Respiratory depression [citation needed]
    • Dizziness
    • Gustatory hallucination
    • High blood pressure [citation needed]
    • Increased bodily temperature [citation needed]
    • Increased heart rate [citation needed]
    • Increased perspiration
    • Motor control loss
    • Muscle cramps
    • Muscle spasms
    • Nausea or Nausea suppression – Datura can be used to treat nausea at low doses. At high, delirium-inducing doses, it can cause significant amounts of nausea, although it rarely leads to vomiting. In some rare cases bile reflux is possible.
    • Olfactory hallucination
    • Physical fatigue
    • Restless leg syndrome
    • Seizures [citation needed]
    • Tactile enhancement
    • Tactile hallucination
    • Tactile suppression
    • Temporary erectile dysfunction
    • Difficulty urinating and Frequent urination– This can be described as a feeling of concrete blocking the urethra, painfully conflicting with a frequent need to urinate.
    • Photosensitivity
    • Pupil dilation – Datura blocks receptors in the muscles of the eye that constrict pupil size. [citation needed] This can result in an extreme sensitivity to light which can last for weeks after the experience in certain cases, also it blocks the accommodation reflex causing vision to be unfocused. [citation needed] Prolonged usage is reputed to cause blindness. [2]

    Visual effects

    • Datura does not enhance the processing of visual stimuli in the same way psychedelics do. Instead, it tends to degrade and decrease visual aptitude while increasing hallucinations and perceptual delusions.
    Suppression
    • Visual acuity suppression – This effect can result in blurry vision to the point of blindness. It sometimes can last for days after the trip itself. [3]
    • Double vision
    • Pattern recognition suppression
    • Vibrating vision
    Distortions
    • Drifting(melting, breathing, morphing and flowing) – In comparison to other hallucinogens, this effect can be described as intricate in complexity; jittery, slow and rigid in motion; static in permanence; realistic in believability and interactive in plasticity
    • After images
    • Visual haze
    • Object alteration
    Hallucinatory states

    Datura is extremely efficient at inducing delirious hallucinations which can be broken into the categories described below:

    • External hallucination (autonomous entities; settings, sceneries, and landscapes; perspective hallucinations and scenarios and plots) – In comparison to other classes of hallucinogen, this effect occurs more frequently than that of any other at moderate to heavy doses and is the defining feature of the experience. It can be comprehensively described through its variations as delirious in believability, autonomous in controllability and solid in style. The most common themes for these hallucinations include those of everyday occurrences such as smoking phantom cigarettes, talking to people who are not there, insects and sinister, nightmarish experiences.
    • Internal hallucination (autonomous entities; settings, sceneries, and landscapes; perspective hallucinations and scenarios and plots) – In comparison to other classes of hallucinogen, this effect occurs briefly and spontaneously at moderate doses but becomes progressively extended in its occurrence and duration proportional to dosage before eventually becoming all-encompassing. It can be comprehensively described through its variations as delirious in believability, interactive in style, equal in new experiences and memory replays in content, autonomous in controllability and solid in style.
    • Peripheral information misinterpretation
    • Shadow people
    • Unspeakable horrors
    • Object activation

    Cognitive effects

    • The cognitive effects of datura are described by many as generally negative and dysphoric, often consisting of extreme paranoia and feelings of impending doom. Like other deliriants, datura is confusing and disorienting, often leading to a complete inability to communicate or understand normal language.
      • Sleepiness – In terms of its effects on the user’s physical energy levels, datura is commonly considered to be extremely tiring.
      • Wakefulness – Even though datura is a depressant overall and causes sleepiness, it has stimulant effects on the body, which can also keep the user awake. This effect predominates sleepiness at higher dosages.
      • Motivation suppression – Datura can cause complete loss of motivation to do anything. This is often accompanied by depression and can make the user extremely bored.
      • Increased libido – Datura stramonium seeds have been known to increase libido and sex drive for a number of its users. Throughout history and still today dried datura seeds have even been boiled or made into ointments with various other ingredients added and occasionally other psychoactive substances which were often applied to the genitals for treating sexual impotency. This however is not recommended due to the plant’s unpredictable levels of toxicity.
      • Amnesia – In some cases this has been known to lead to anterograde amnesia which is a persisting negative effect on the user’s memory capacity that occurs even after the experience has ended. This effect causes one to have difficulty forming new memories directly after and as a result of an amnesic episode.
      • Anxiety
      • Cognitive dysphoria – The levels of dysphoria experienced, however, vary between people with a very small percentage of users reporting that they do not seem to experience them at all.
      • Cognitive fatigue
      • Confusion
      • Delirium
      • Delusion
      • Depersonalization
      • Depression
      • Derealization
      • Dream potentiation
      • Emotion suppression
      • Feelings of impending doom
      • Focus suppression
      • Information processing suppression
      • Language suppression
      • Memory suppression
      • Paranoia
      • Psychosis
      • Suggestibility enhancement
      • Time distortion
      • Thought deceleration
      • Thought disorganization

      Auditory effects

      After effects

      • Due to its stimulant and deliriant effects, datura can cause mild to significant after effects when “coming down”. These effects commonly include:
        • Anxiety
        • Brightness alteration – This can often manifest itself in the form of photophobia.
        • Cognitive fatigue
        • Dehydration
        • Delirium – This possible after effect is not as consistent or as long lasting usually but can be more likely to present itself if taken consecutively or in high dosages. In rare circumstances or when taken too frequently, this can display itself in the form of temporary or even long-term psychosis and a general disconnection from reality.
        • Depression
        • Language suppression
        • Motivation suppression
        • Peripheral information misinterpretation
        • Pupil dilation – This often tends towards the individual experiencing diffraction even long after the initial intoxication has worn off.
        • Sleepiness
        • Thought deceleration
        • Visual acuity suppression – This often consists of a feeling of being temporarily farsighted and often renders one unable to read due to heavily blurred vision.

        Experience reports

        Anecdotal reports which describe the effects of this compound within our experience index include:

        • Experience: 450 Datura seeds – Talking to Ghosts
        • Experience:Datura & DPH – Results of Experiment by Isopropanol
        • Experience:Datura Alcoholic Tincture
        • Experience:Datura and nicotine smoked – 4 and ~15 hits; was actually quite pleasant

        Additional experience reports can be found here:

        Natural plant sources

        Due to its extensive cultivation and naturalization throughout the temperate and tropical regions, datura is found in most areas of the world. There are nine identified species:

        Toxicity and harm potential

        This toxicity and harm potential section is a dangerously wrong information! You can help by expanding upon or correcting it.
        Note: Always conduct independent research and use harm reduction practices if using this substance.

        Datura is known to be extremely unpredictable and has the potential to result in severe consequences, hospitalization or death. The toxicity and long-term health effects of regular datura usage do not seem to have been studied in any scientific context and the exact toxic dosage is unknown. This is because long-term datura usage is very rare and the vast majority of people who try it do not desire to repeat the experience.

        In traditional cultures, a great deal of experience with and detailed knowledge of datura was critical to minimize harm. [4] [5] Many fatal incidents result from modern users ingesting datura. For example, in the 1990s and 2000s, the United States media contained stories of adolescents and young adults dying or becoming seriously ill from intentionally ingesting datura. [6] [7] There are also several reports in the medical literature of deaths from D. stramonium and D. ferox intoxication. [8] [9] [10] Children are especially vulnerable to atropine poisoning and their prognosis is likely to be fatal. [11] [12]

        In some parts of Europe and India, datura has been a popular poison for suicide and murder. From 1950 to 1965, the State Chemical Laboratories in Agra, India investigated 2,778 deaths caused by ingesting datura. [13] [14] [15]

        Psychosis

        Datura has been reported to cause psychosis and delirium at a significantly higher rate than other hallucinogens like LSD, ketamine, or DMT. There are a large number of experience reports online which describe states of psychotic delirium, amnesia, and other serious consequences after abusing the drug. In many cases, it has resulted in hospitalization and death.

        Lethal dosage

        There can be a 5:1 potency variation between plants and a given plant’s toxicity depends on its age, where it is growing, and the local weather conditions. This variation makes datura exceptionally hazardous as a drug and there is no way for the common man to accurately measure the dosage of any given plant. Datura has been used for centuries in some cultures as a poison because of the presence of these substances. [16] [17]

        The safest way to prevent overdose is to grind the dried plant matter into an extremely fine and even powder so that the active chemicals within them are distributed evenly across itself. From here, one can slowly work their way up in extremely small increments until the correct dose for that particular plant is found.

        It is strongly advised that one avoid using datura altogether. Otherwise, extreme caution and harm reduction practices should be used, such as having a sober and prepared trip sitter present throughout the experience.

        Tolerance and addiction potential

        The use of datura can be considered mildly addictive with a high potential for adverse side effects such as psychosis. Datura is reported to be significantly less addictive than than other substances because the vast majority of people who try it do not wish to repeat the experience.

        Tolerance to many of the effects of datura develops with repeated use. This results in users having to administer increasingly large doses to achieve the same effects. After that, it takes about 3 – 7 days for the tolerance to be reduced to half and 1 – 2 weeks to be back at baseline (in the absence of further consumption). Datura presents cross-tolerance with deliriants, meaning that after the consumption of datura, all deliriants will have a reduced effect.

        Legal status

        This legality section is a stub.

        As such, it may contain incomplete or wrong information. You can help by expanding it.

        Datura grows naturally and is legal to grow, sell and consume in most parts of the world. It is, however, restricted within the following countries:

        Jimson Weed

        Angel Tulip, Chasse-Taupe, Datura, Datura inermis, Datura lurida, Datura Officinal, Datura Parviflora, Datura stramonium, Datura tatula, Devil’s Apple, Devil’s Trumpet, Endormeuse, Estramonio, Herbe du Diable, Herbe aux Magiciens, Herbe aux Sorciers, Herbe aux Taupes, Higuera del Diablo, Jamestown Weed, Locoweed, Mad-apple, Man Tao Luo, Nightshade, Peru-apple, Pomme Épineuse, Pomme Poison, Pommette Féroce, Stinkweed, Stinkwort, Stramoine, Stramoine Commune, Stramonium, Thorn-apple, Trompette des Anges, Trompette de la Mort, Yiang Jin Hua.

        Overview

        Jimson weed is a plant. The leaves and seeds are used to make medicine.

        Despite serious safety concerns, jimson weed is used to treat asthma, cough, flu (influenza), swine flu, and nerve diseases.

        Some people use it as a recreational drug to cause hallucinations and a heightened sense of well-being (euphoria).

        How does it work?

        Jimson weed contains chemicals such as atropine, hyoscyamine, and scopolamine. These chemicals interfere with one of the chemical messengers (acetylcholine) in the brain and nerves.

        QUESTION

        Uses & Effectiveness

        Insufficient Evidence to Rate Effectiveness for.
        • Asthma.
        • Cough.
        • Nerve diseases.
        • Causing hallucinations and elevated mood (euphoria).
        • Other conditions.

        Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

        Side Effects

        Jimson weed is UNSAFE when taken by mouth or inhaled. It is poisonous and can cause many toxic effects including dry mouth and extreme thirst, vision problems, nausea and vomiting, fast heart rate, hallucinations, high temperature, seizures, confusion, loss of consciousness, breathing problems, and death. The deadly dose for adults is 15-100 grams of leaf or 15-25 grams of the seeds.

        SLIDESHOW

        Special Precautions & Warnings

        No one should take jimson weed, but certain people are especially at risk for toxic side effects. These side effects are especially dangerous if you have any of the following conditions:

        Children: Jimson weed is UNSAFE when taken by mouth or inhaled by children. They are more sensitive than adults to the toxic effects of jimson weed. Even a small amount can kill them.

        Pregnancy and breast-feeding: Jimson weed is UNSAFE for both mother and child when taken by mouth or inhaled.

        Congestive heart failure (CHF): Jimson weed might cause rapid heartbeat and make CHF worse.

        Constipation: Jimson weed might cause constipation.

        Down syndrome: People with Down syndrome might be especially sensitive to the dangerous side effects of jimson weed.

        Seizures: Jimson weed can cause seizures. Do not use jimson weed if you suffer from frequent seizures.

        Esophageal reflux: In esophageal reflux, food and liquid in the stomach leak backwards into the tube that connects the mouth to the stomach (esophagus). Jimson weed might make this condition worse because it slows down the process that empties the stomach. It also lowers the pressure in the bottom of the esophagus, making it more likely that stomach contents will go back up.

        Fever: Jimson weed might make fever worse.

        Stomach ulcer: Jimson weed might delay stomach emptying and make ulcers worse.

        Stomach and intestinal infections: Jimson weed might slow down the emptying of the stomach and intestines. As a result, “bad” bacteria and the toxins they produce could remain in the digestive tract longer than usual. This could make infections caused by these bacteria worse.

        Hiatal hernia: Hiatal hernia is a condition in which part of the stomach is pushed up into the chest through a hole or tear in the diaphragm. The diaphragm is the muscle that separates the chest space from the stomach space. Taking jimson weed might make hiatal hernia worse. It can slow down the process that empties the stomach.

        Glaucoma: Glaucoma is an eye disease. It raises the pressure inside the eye and can lead to blindness, if it isn’t treated. Jimson weed is especially dangerous for people with glaucoma because it might raise the pressure inside the eye even more.

        Obstructive digestive tract disorders, including atony, paralytic ileus, and stenosis: Jimson weed might make these conditions worse.

        Rapid heartbeat: Jimson weed might make this condition worse.

        Toxic megacolon: In this life-threatening condition, the large intestine (colon) suddenly becomes extra wide because of an infection or other intestinal disorder. Taking jimson weed might make this condition worse.

        Ulcerative colitis: This is an inflammatory bowel disorder that affects the large intestine. Taking jimson weed might make this condition worse.

        Difficulty passing urine (urinary retention): Taking jimson weed might make this condition worse.

        Interactions

        Drying medications (Anticholinergic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

        Jimson weed contains chemicals that cause a drying effect. It also affects the brain and heart. Drying medications called anticholinergic drugs can also cause these effects. Taking jimson weed and drying medications together might cause side effects including dry skin, dizziness, low blood pressure, fast heartbeat, and other serious side effects.

        Some of these drying medications include atropine, scopolamine, and some medications used for allergies (antihistamines), and for depression (antidepressants).

        Dosing

        The appropriate dose of jimson weed depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for jimson weed. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

        Report Problems to the Food and Drug Administration

        You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

        Health Solutions From Our Sponsors

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        Jimson Weed Poisoning—A Case Report

        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]

        Abstract

        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.1 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 99.3°F (37.4°C), 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.2 The same plant is known also as thorn apple, angel’s trumpet, stinkweed, and green dragon.1,2 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.3,4

        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.1,5 Although all parts of the plant are poisonous, the leaves and seeds contain the highest concentration of atropine, hyoscyamine, and scopolamine. 6 One hundred seeds contain approximately 6 mg of atropine.2,5 A dose of atropine exceeding 10 mg is regarded as potentially lethal.2

        Today, jimson weed poisoning is found primarily among adolescents who seek the hallucinogenic effects of the plant.7 In 1998, 152 cases of jimson weed poisoning were reported nationally to the American Association of Poison Control Centers, but the true number of cases is undoubtedly far higher.1

        The anticholinergic effects of jimson weed are attributed to the atropine, hyoscyamine, and scopolamine components. Symptoms of jimson weed toxicity usually occur within 30 to 60 minutes after ingestion. Initial symptoms include hallucinations, dry mucous membranes, thirst, dilated pupils, blurred vision, and difficulty speaking and swallowing. 2 Subsequent effects may include tachycardia, urinary retention, and ileus. Rarely, late symptoms may include hyperthermia, respiratory arrest, and episodes of seizure.6 Slowing of gastrointestinal motility may prolong elimination of the toxin, thus causing symptoms to persist for 24 to 48 hours.

        Classic anticholinergic symptoms include mydriasis; dry, flushed skin; hallucinations; agitation; hyperthermia; urinary retention; delayed intestinal motility; tachycardia; and episodes of seizure.3,5,7,8 The mnemonic for anticholinergic symptoms—“blind as a bat, dry as a bone, red as a beet, mad as a hatter, and hot as a hare”—thus applies well to jimson weed poisoning.

        Effective treatment of jimson weed poisoning requires a primary survey, clinical evaluation and recognition, elimination of the poison, supportive treatment, and continuing observation. 8 The primary survey includes assessment of the ABCs—ie, airway, breathing, and circulation. Although rare, some patients with jimson weed intoxication may be seen for episodes of seizure or coma. If compromise of the airway is suspected, prompt intubation and mechanical ventilation are indicated.

        A detailed history and physical examination results obtained after the patient’s condition is initially stabilized can often give clues leading to diagnosis of anticholinergic toxidrome, even if jimson weed poisoning is not immediately identified. A common presenting complaint is altered mental status. The patient may have visual hallucinations, auditory hallucinations, or both.9 Physical examination may show tachycardia and elevated blood pressure. Hyperpyrexia is seen in about 20% of the cases.3 Other manifestations include mydriasis, blurred vision, decreased bowel sounds, and dry mucous membranes.

        A toxicology screen is useful to rule out concomitant use of other drugs. Most documented lethal cases of jimson weed ingestion occur in persons with polysubstance abuse, including use of jimson weed combined with alcohol, marijuana, or cocaine.7 Drug screens usually do not detect pure anticholinergic poisons, and other laboratory tests are usually not helpful for identifying jimson weed as the cause of symptoms.3

        Absorption of jimson weed may be minimized either by using an agent that binds to the toxins or through removal of gastric contents by inducing emesis or administering gastric lavage. Activated charcoal binds to the toxins in jimson weed and decreases overall absorption of these toxins.5 The usual oral dose of activated charcoal for adults is 1 g/kg. If medical attention is sought within several hours after ingestion or if the patient has been intubated, removal of the ingested plant by gastric lavage can be considered. Emesis may be induced by using syrup of ipecac if the patient is awake and relatively alert. The usual dose of ipecac is 30 mL for adults and 15 mL for children.3,5

        After initial assessment and attempts to eliminate the toxin from the gastrointestinal tract, most cases of jimson weed poisoning can be managed simply with observation until symptoms resolve. However, cardiac monitoring, serial recording of vital signs, and serial neurologic assessment are important for detecting occasional occurrence of life-threatening events and for establishing resolution of symptoms. Serial examinations usually indicate improvement within 24 hours, and most patients need less than 48 hours of observation.10

        Patients with anticholinergic poisoning should be observed by using a cardiac monitor because of the risk for tachyarrhythmia from inhibition of vagal effect on the sinoatrial node.9 Propanolol may be used for treating symptomatic tachyarrhythmia; the dosage for adults is 1 mg given intravenously for one minute and repeated every five minutes (maximum dose, 5 mg); the dosage for children is 0.01 to 0.1 mg/kg, (maximum dose, 1 mg).3

        Patients also need close observation for hyperpyrexia and convulsions, because either condition can be fatal.5 Cooling measures (eg, sponging or a cooling blanket) may be used to treat hyperpyrexia, and intravenous fluid resuscitation may prevent this complication. Convulsions may be treated initially with benzodiazepine therapy.5 Hypertension is usually transient and usually does not necessitate pharmacologic intervention unless hypertensive crisis is suspected.9

        In severe cases in which patients have symptoms of anticholinergic crisis (eg, dysrhythmia, coma, seizures, clinically significant hypertension, or poorly controlled hyperpyrexia), the use of physostigmine is warranted.5 Physostigmine is an acetylcholinesterase inhibitor and can therefore reverse the peripheral and central manifestations of anticholinergic excess.11 The initial dose of physostigmine is 0.5 to 2 mg in adults or 0.02 mg/kg in children, to whom the drug is given slowly by intravenous route. The maximum dose in adults should not exceed 4 mg in 30 minutes. 3 Clinicians must remember that use of physostigmine carries risks and that excess acetylcholine may induce a cholinergic crisis, symptoms of which include bradycardia, complete atrioventricular block, asystole, emesis, bronchorrhea, and seizures.5 If overcorrection is suspected (eg, as manifested by cholinergic symptoms), 0.5 mg of atropine may be given intravenously for every 1 mg of physostigmine given.9

        Practice Tips
        Jimson weed is popular among adolescents curious about the plant’s hallucinogenic effects.
        Anticipatory counseling for teenagers and parents may also prevent experimentation and resultant harm.
        Jimson weed reaches a height of five feet and consists of large, jagged leaves and trumpet-shaped white or purple flowers.
        Intoxication results in anticholinergic effects. Initial symptoms include restlessness, shaking, hallucinations, dry mucous membranes, thirst, dilated pupils, blurred vision, and difficulty speaking and swallowing.
        The mnemonic for anticholinergic symptoms—“blind as a bat, dry as a bone, red as a beet, mad as a hatter, and hot as a hare.”
        Treatment may include: activated charcoal, emesis, cardiac monitoring, propanolol, cooling measures, benzodiazepine and physostigmine.

        Routine use of physostigmine to treat jimson weed intoxication remains controversial. Closely monitored use of physostigmine in very small doses to prevent cholinergic excess may be safe: When used to treat a series of 23 patients with hallucinations from jimson weed intoxication, physostigmine had no adverse effects.11 Physostigmine can quickly reverse signs and symptoms of central and peripheral nervous system dysfunction and can assist diagnosis of anticholinergic excess.12 However, most cases of jimson weed poisoning have a benign outcome after treatment with only supportive care and observation; use of physostigmine is therefore not routine and should be reserved for patients who have clinically significant symptoms or complications.

        Benzodiazepine therapy is the main treatment for acute agitation, and use of restraints may be necessary to avoid injury to the patient or hospital staff. Clinicians must remember that drugs with anticholinergic properties (eg, some antipsychotic and sedative drugs) can worsen symptoms of jimson weed poisoning. Agents such as haloperidol or chlorpromazine can exacerbate agitation, and psychosis and should therefore be avoided.12

        Conclusion

        Jimson weed poisoning produces classic anticholinergic symptoms, is usually self-limiting, and usually requires only supportive measures and observation. Recognizing the signs and symptoms of anticholinergic poisoning can help clinicians identify the toxidrome early and intervene appropriately in life-threatening cases, which occur rarely. High levels of jimson weed ingestion may produce dangerous medical conditions, such as cardiac arrhythmia, hyperpyrexia, seizures, coma, and respiratory arrest. Physostigmine is the preferred treatment for severe cases of jimson weed poisoning, and benzodiazepine therapy is the preferred treatment for agitation. Anticipatory counseling, especially around summer and early fall (when the jimson weed plant matures), may help deter adolescents from experimental use of this plant.

        Acknowledgment

        Robert E Sallis, MD, reviewed the manuscript.

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