title: Anticholinergic toxicity from nightshade berry poisoning responsive to physostigmine.
abstract: The woody nightshade, Solanum dulcamara, belongs to the genus Solanum and its primary toxin is solanine. We report a large nightshade ingestion in a 4-yr-old girl who presented to the emergency department in acute anticholinergic crisis. The child was given 0.2 mg of intravenous physostigmine (0.02 mg/kg). Within 50 min, the patient received two additional equal doses with complete resolution of symptoms. After 36 h of observation, the child was discharged. Our patient presented with symptoms more suggestive of the deadly nightshade species, Atropa belladonna, which is native to Europe; however, a detailed laboratory analysis of the suspect berries revealed no atropine or hyoscyamine. Analysis did reveal sterols consistent with solanine. This is a unique case presentation of woody nightshade, S. dulcamara, poisoning presenting with anticholinergic crisis and responding to physostigmine.
authors.affiliation: Cook County Hospital Department of Emergency Medicine, University of Illinois College of Pharmacy, Chicago, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Ceha
authors.forename: C
authors.initials: C
authors.lastname: Presperin
authors.forename: E
authors.initials: E
authors.lastname: Young
authors.forename: M
authors.initials: M
authors.lastname: Allswede
authors.forename: T
authors.initials: T
authors.lastname: Erickson
mesh_terms: D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000032:analysis / Q000506:poisoning; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D010830:Physostigmine / Q000627:therapeutic use*; D010939:Plant Poisoning / Q000188:drug therapy*; D010947:Plants, Toxic / Q000737:chemistry; D012991:Solanaceous Alkaloids / Q000032:analysis / Q000506:poisoning*
chemical_list: D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors; D012991:Solanaceous Alkaloids; D010830:Physostigmine