Successful Treatment of A Belladonna Poisoning with Physostigmine
Semih Değerli̇, Gökhan Yi̇ldi̇z, Eyüp Horasanlı
Keçiören Training and Research Hospital, Anesthesiology and Reanimation Clinic, TURKEY
İntroduction/AIM: Belladonna is a poisonous plant. Because plant leave sand fruits highly contain atropine alkaloids such as scopolamine andhyoscyamin.These alkaloids, competitively inhibits muscarinic receptors in the central nervous system. Also post ganglionic muscarinic receptors are affected. Blocking of these receptors leads to clinical manifestations that may lead convulsions and coma. Sometimes it can also manifest itself with psychosis and hallucinations. In this case, we present a patient who admitted to the emergency room with hallucinations after eating plenty of belladonna berries. CASE: A 23-year-oldmale patient was admitted to emergency department with complaints of hallucinations and deterioration in the general condition. Glasgow coma scale (GCS) was 13. Arterial blood pressure, heart rate, respiratory rate, temperature were 150/75 mm Hg,101/ min, 17/ min. and 37 C respectively. He did not have any additional disease. But approximately 8hours ago he had eaten black fruits during the picnic. Later it was noticed that the fruits were belladonna. The patient was in an anticholinergictoxic condition. Patient's stomach was aspirated with a nasogastrictube after irrigation with isotonic saline. Then activated charcoal 1 gr/ kg was administered. Physostigmine 1 mg was administered with recommendation of the National Poison Control Center in ICU. After a total 4 mg physostigmine consciousness was recovered and hallucinations were resolved completely. One day later the patient was transferred to the ward without any problem. CONCLUSION: Medical history of the patients with anticholinergic symptoms should be taken very cautiously. Inparticular, the comatose or confused patients should be quickly followed under intensive care conditions. Also physostigmine should be immediately administered after gastric lavage as an early treatment. As in our patient, we believe that early application of physostigmine and gastric lavage are life savers.
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