title: Effect of physostigmine and gastric lavage in a Datura stramonium-induced anticholinergic poisoning epidemic.
abstract: This study examines the impact of the administration of physostigmine and of nasogastric evacuation of Jimsonweed seeds on intensive-care unit (ICU) use and the length of stay in the hospital after Jimsonweed poisoning. Clinical data for this retrospective study were gathered from records of consecutive patients treated for Jimsonweed poisoning from September to November 1997. Descriptive statistics, Fisher's exact test, and Student t-test were used to analyze important clinical and sociodemographic variables. There were 17 victims of the Jimsonweed ingestion epidemic, all of whom presented with an anticholinergic toxidrome 3 to 9 hours after ingestion. Reported quantities of seed ingestion ranged from a low of 7 seeds to as high as 200 seeds. Altered mentation, manifested by combative behavior, necessitated admission of 13 patients to the ICU. The administration of physostigmine did not reduce admissions to the ICU (P = 0.54) or reduce length of stay in the hospital (P = 0.45) compared with the use of benzodiazepines alone. Nasogastric lavage was performed in 14 (82%) and seeds were recovered in 8 (57%) of those lavaged. The successful removal of Jimsonweed seeds did not decrease ICU use rates (P = 0.68) or shorten length of stay in the hospital compared with not recovering seeds (P = 0.85). The use of physostigmine and the successful nasogastric lavage of Jimsonweed seeds did not result in decreased intensive-care use or shorter length of stay in the hospital for Jimsonweed-induced anticholinergic toxicity.
authors.affiliation: Department of Emergency Medicine, St. Luke's Hospital, Bethlehem, PA 18015, USA. salenp@sihn.org
authors.forename: Philip
authors.initials: P
authors.lastname: Salen
authors.forename: Richard
authors.initials: R
authors.lastname: Shih
authors.forename: Paul
authors.initials: P
authors.lastname: Sierzenski
authors.forename: James
authors.initials: J
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D000328:Adult; D001569:Benzodiazepines / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000506:poisoning*; D013286:Datura stramonium / Q000506:poisoning*; D005260:Female; D005751:Gastric Lavage / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D010830:Physostigmine / Q000627:therapeutic use*; D011041:Poisoning / Q000628:therapy; D012189:Retrospective Studies; D012639:Seeds
chemical_list: D018680:Cholinergic Antagonists; D001569:Benzodiazepines; D010830:Physostigmine