Plasma level of atropine after accidental ingestion of Atropa belladonna.
BACKGROUND
Ingestion of toxic plant constituents still poses a challenge in clinical management. The amount of berries ingested is often unclear and in the case of Atropa belladonna may affect clinical outcome. Plasma levels of atropine may thus be useful in confirming the cause of intoxication.


METHODS
A 48-year-old man had ingested three handfuls of Atropa belladonna. Within 6 h he experienced phases of disorientation, aggressiveness, and tachycardia. He was initially treated with diazepam, an intravenous infusion of physostigmine and activated charcoal. After temporary improvement his clinical condition worsened and he was transferred to our toxicological intensive care unit. Here, ongoing sedation and continuous administration of physostigmine was necessary because of disorientation. In the early phase of hospitalization, a blood sample was taken and a muscarinic receptor total binding equivalent to binding of 130 microg/L atropine was determined by a radio receptor technique. Within 2 days the patient recovered completely and was discharged in a good general condition.


CONCLUSIONS
Receptor binding may help confirm diagnosis and elucidate mechanisms in this type of exposure.
Bogan
Reinhard
R
Central Institute of the Bundeswehr Medical Service, München, Germany. reinhardbogan@ bundeswehr.org
Zimmermann
Thomas
T
Zilker
Thomas
T
Eyer
Florian
F
Thiermann
Horst
H
D000374:Aggression / Q000187:drug effects; D000931:Antidotes / Q000008:administration & dosage; D001532:Atropa belladonna / Q000378:metabolism / Q000506:poisoning*; D001285:Atropine / Q000097:blood / Q000506:poisoning*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage; D003221:Confusion / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D003975:Diazepam / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010830:Physostigmine / Q000008:administration & dosage; D010939:Plant Poisoning / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D010947:Plants, Toxic / Q000506:poisoning*; D011976:Receptors, Muscarinic / Q000378:metabolism; D013610:Tachycardia / Q000188:drug therapy; D016896:Treatment Outcome
D000931:Antidotes; D002800:Cholinesterase Inhibitors; D011976:Receptors, Muscarinic; D001285:Atropine; D010830:Physostigmine; D003975:Diazepam