title: Use of physostigmine for hallucinogenic plant poisoning in a teenager:  case report and review of the literature.
abstract: The objective of this study was to utilize a case report to review the use of physostigmine for jimsonweed intoxication. A 15-year-old girl was found at school hallucinating and incoherent. Upon presentation to the emergency department, she was found to be tachycardic and confused with dilated pupils and dry, flushed, hot skin. She was admitted to our institution. Hallucinations and symptoms resolved after the use of physostigmine. She subsequently admitted to ingesting 'moonflower seeds,' which are derived from Jimsonweed (Datura stramonium). She was discharged when she got well. Jimsonweed is known to contain high concentrations of anticholinergic substances; hence, ingestion can result in the anticholinergic toxidrome. Signs and symptoms include hallucinations, tachycardia, dilated pupils, and disorientation. In our patient, the use of the physostigmine as an antidote resulted in a favorable outcome without any complications. Ingestion of the Datura species can result in severe toxicity. Each plant varies in the concentrations of alkaloid substances. For this reason, it is very important for individuals to become educated on the toxicities and potential risks associated with recreational use of these plants. The use of physostigmine can help in both the diagnosis and management of patients intoxicated with these substances.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Miguel Marcelo
authors.initials: MM
authors.lastname: Glatstein
authors.forename: Fatoumah
authors.initials: F
authors.lastname: Alabdulrazzaq
authors.forename: Facundo
authors.initials: F
authors.lastname: Garcia-Bournissen
authors.forename: Dennis
authors.initials: D
authors.lastname: Scolnik
mesh_terms: D000293:Adolescent; D000931:Antidotes / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D013286:Datura stramonium / Q000506:poisoning*; D005260:Female; D006213:Hallucinogens / Q000506:poisoning*; D006801:Humans; D010830:Physostigmine / Q000627:therapeutic use*; D010939:Plant Poisoning / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000931:Antidotes; D002800:Cholinesterase Inhibitors; D006213:Hallucinogens; D010830:Physostigmine