title: Chinese herbal medicine-induced anticholinergic poisoning in Hong Kong.
abstract: OBJECTIVE
  To study the epidemiology, causes, and clinical course of Chinese herbal medicine-induced anticholinergic poisoning in Hong Kong.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Hong Kong.
  
  
  METHODS
  All case histories of Chinese herbal medicine-induced anticholinergic poisoning (with laboratory confirmation) recorded by the Hong Kong Poison Information Centre over a 93-month period were accessed for analysis.
  
  
  RESULTS
  During the relevant period, 22 clusters of Chinese herbal medicine-induced anticholinergic poisoning involving 32 patients were retrieved. The commonest clinical features were mydriasis (n=32, 100%) and confusion (n=24, 75%). No gastro-intestinal decontamination was performed. None of these patients underwent intubation, defibrillation, cardioversion, pacing, fluid resuscitation, inotropic support or dialysis. Of the 32 patients, 17 (53%) were treated with physostigmine because of confusion, three of whom had previously received intravenous benzodiazepines. No patient could be effectively treated with benzodiazepines alone. There was no mortality, and all the patients were discharged within 3 days. None of them re-attended the emergency department within 1 week of discharge. The commonest cause was the substitution of flos campsis (Campsis grandiflora) by the flower of the Datura species (7 clusters [32%] in 10 patients).
  
  
  CONCLUSIONS
  Mydriasis and confusion were the commonest clinical features of Chinese herbal medicine-induced anticholinergic poisoning in Hong Kong. Physostigmine was frequently used in the treatment; benzodiazepines appeared ineffective. The commonest cause was the substitution of flos campsis (Campsis grandiflora) by the flower of the Datura species.
authors: Hong Kong Poison Information Centre, United Christian Hospital, Kwun Tong, Hong Kong. bklcheng@gmail.com
authors: K L
authors: KL
authors: Cheng
authors: Y C
authors: YC
authors: Chan
authors: Tony W L
authors: TW
authors: Mak
authors: M L
authors: ML
authors: Tse
authors: F L
authors: FL
authors: Lau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000506:poisoning*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D016000:Cluster Analysis; D004365:Drugs, Chinese Herbal / Q000506:poisoning*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010830:Physostigmine / Q000627:therapeutic use*; D011039:Poison Control Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors; D004365:Drugs, Chinese Herbal; D001569:Benzodiazepines; D010830:Physostigmine