[Acute Datura stramonium poisoning in an emergency department].
BACKGROUND
The toxic effects of Datura stramonium most often include visual and auditory hallucinations, confusion and agitation. Severe and even fatal complications (coma, respiratory distress or death in more than 5% of cases) are not rare since the lethal concentration of the drug's toxic substances (i.e., atropine and scopolamine) is close to the level at which delirium occurs.


METHODS
A 17-year-old man was admitted to our emergency department with agitation, delirium with persecutory ideation and frightening hallucinations of being assaulted by animals. Blood samples taken 12 hours after Datura stramonium ingestion and analyzed with liquid chromatography and mass spectrometry (LC-MS/MS) found 1.7 ng/mL of atropine, close to the lethal level. After restraint and treatment with the antipsychotic drug cyamemazine, the young man returned to normal 36 hours after drug ingestion. A 17-year-old woman was admitted to our emergency department after losing consciousness on a public thoroughfare. At the emergency department, 2 hours after she had ingested Datura stramonium, she was agitated, with delirium, anxiety, and frightening visual and tactile hallucination of green turtles walking on her as well as auditory hallucinations. Blood samples at D0, D1 and D2 after Datura stramonium ingestion, analyzed with LC-MS/MS, found: 1.4, 1.0, and 0.2 ng/mL of scopolamine, respectively. Atropine was massively eliminated in urine on D1 (114 ng/mL). After restraint and cyamemazine treatment, the young woman returned to normal 40 hours after she had first ingested this hallucinogen.


CONCLUSIONS
These cases of intoxication with Datura stramonium are, to our knowledge, the first clinical reports correlated with toxicologic analysis by the reference method (LC-MS/MS) in an emergency setting. Since neither the drug-users nor those accompanying them usually volunteer information about drug use, it is important to consider this specific risk in cases of agitation and confusion in adolescents or young adults.
Marc
Bernard
B
Urgences médico-judiciaires, Centre hospitalier, Compiègne. b.marc@ch-compiegne.fr
Martis
Antoine
A
Moreau
Céline
C
Arlie
Gilles
G
Kintz
Pascal
P
Leclerc
Johan
J
D000208:Acute Disease; D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001285:Atropine / Q000097:blood / Q000652:urine; D002853:Chromatography, Liquid; D013286:Datura stramonium / Q000506:poisoning*; D004630:Emergencies; D005260:Female; D006213:Hallucinogens / Q000506:poisoning*; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D010640:Phenothiazines / Q000627:therapeutic use; D011041:Poisoning / Q000097:blood / Q000188:drug therapy; D012601:Scopolamine / Q000097:blood; D019966:Substance-Related Disorders; D013997:Time Factors; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D006213:Hallucinogens; D010640:Phenothiazines; D001285:Atropine; C028457:cyamemazine; D012601:Scopolamine