Deadly Datura

Below is text from the Salt Lake Tribune, September 29 and 30, 1998, and from the Morbidity and Mortality Weekly Report (MMWR) of May 25, 1984 and January 27, 1995.

Tuesday, September 29, 1998
Jimson Weed Sends 3 Teens To the Hospital

Three Wasatch Front teen-agers were admitted into intensive care at Pioneer Valley Hospital on Saturday night after ingesting seeds of jimson weed, a flowering poisonous plant common in Utah. The boys -- Kevin Simmons, 17, and Paul Butterfield, 13, both from West Valley City, and an unidentified 13-year-old from Bountiful -- are recuperating. They remained in the hospital Monday night in stable condition.

The teens broke open the thistle-like pods of the Datura stramonium plant -- also known as loco weed and Sacred Datura -- and swallowed the seeds inside. Within half an hour they started hallucinating, the effect they were told to expect from friends. What they weren't counting on was a trip to Pioneer Valley Hospital, said Kevin's mother, Sherrie Simmons. ``They had heard about this weed growing in the neighborhood, that they could eat the seeds and it would get them high,'' Sherrie Simmons said, adding that the plant was growing in her neighbor's yard.

The plant, featured on the book cover of artist Georgia O'Keeffe's 100 Flower Paintings, has white trumpet-like blossoms and blue-green spineless leaves. Paul Butterfield returned home with the other boy, and Kevin Simmons went into a downstairs room of his house. The Simmons and Butterfield parents noticed the youths were acting strangely, and soon it became apparent they were hallucinating. ``He couldn't even walk,'' said Paul's mother, Cheri Butterfield. ``He looked at me like he was scared to death.''

The boys confessed they had swallowed some seeds and were taken to the hospital. All three were admitted into the emergency room with rapid heart rates ranging from 110 to 140 beats per minute, irregular breathing, muscle twitches, dilated pupils and severe hallucinations, said Pioneer Valley doctor Peter Taillac. ``When they start having hallucinations, they get scared and the whole thing intensifies and it can be serious, it can cause seizures and it could cause death if enough is taken,'' said Doug Rollins, medical director of the Utah Poison Control Center.

``We're probably only seeing the tip of the iceberg. This is evidently a popular thing among high school students because they can get these plants everywhere. They need to know that there is a consequence of doing this, just like taking any other drug.'' Sherrie Simmons agreed. ``These kids know it's out there, they just don't know how poisonous it is. We've got to let others know what it's done to these three boys. If people have this plant on their property, they need to remove it.''

History shows more than a few lives have been taken by this plant, said Zell McGee, a professor of medicine and pathology at University of Utah and an expert on Datura stramonium. -- Five teens in Tasmania ingested the plant and all but one drowned in 6 inches of water after hallucinations convinced them they were fish. -- A federal disease control publication several years ago described how a woman and her husband died after she mistook a jar of the seeds for spice and sprinkled them on their salad. -- The name jimson weed is actually a contraction for Jamestown, Va., and derives from an incident where British soldiers guarding colonists noticed Indians eating loco weed and tried it and died. -- A Harvard anthropologist has described how voodoo doctors in Haiti used the plant to lower people's metabolisms so much they were believed to be dead and were buried alive. The doctors then would dig those people up, give them an antidote and awaken them to show their voodoo power -- bringing dead people back to life. The doctors then would give those people lower doses of poison to stifle their level of awareness. That left them in a stuporous, zombie-like state, and they were subsequently forced into slavery. ``In short, don't mess with this plant,'' McGee said. ``As a drug, it is too dangerous.'' Copyright 1998, The Salt Lake Tribune

Wednesday, September 30, 1998
Jimson Weed Lands Price Teens in Hospital

PRICE -- Three Wasatch Front teen-agers hospitalized last weekend after taking seeds of the jimson weed are not the only ones who have landed in the emergency room suffering from the physical and mental effects of the seeds.

In the past two weeks, a dozen teen-agers in Price have been to the hospital, two of them in intensive care, after becoming intoxicated from consuming parts of the plant. ``This is a really a big concern to us,'' Castleview Hospital nursing supervisor Bonnie Cook said Tuesday. ``It is really dumb and can be fatal. The problem is they don't know the dosage they are taking. At least with the common stupid drugs some kids take, there is a dosage.'' The three Wasatch Front teens who were admitted into the intensive-care unit at Pioneer Valley Hospital last weekend are out of ICU and were in stable condition at the hospital Tuesday night, said hospital spokeswoman Dawn Booth. A check of other Utah emergency rooms revealed only one other case of jimson-weed overdose, that of a 14-year-old admitted for two days at Primary Children's Medical Center in Salt Lake City in October 1997. Cook believes at least one of the Price teens ate the seeds from the plant's pods because they were found after the teenager's stomach was pumped. Signs of a jimson-weed overdose, according to Cook, include a red face, dry mouth, dilated pupils and hallucinations. ``They are red as a beet, dry as a bone, blind as a bat and mad as a hatter,'' she said. The biggest danger to a person from ingesting the plant is that the heart rate can increase to 110 to 150 beats per minute. ``It can lead to a fast heart rate, coma and sometimes death,'' said Cook. Once doctors verify the plant's presence in a patient through a urine test, the stomach is pumped. Sometimes people become so agitated that sedatives are needed to calm them down, said Cook. ``We had to restrain one boy because he kept trying to bite everyone around him,'' said Cook. ``Frequently they wake up and can't remember anything they did, which is sometimes a good thing. Hearing that you tried to bite someone would tend to be embarrassing.'' Cook said if parents notice their children staggering around, breathing fast, with dilated pupils and displaying strange, combative behavior, they should take them to a hospital emergency room immediately.

The plant is commonly called by several different names, including moon flower, angel's trumpet, loco weed, and datura. It grows in sandy soil, has large bluish-green leaves and produces a large white trumpet-shaped blossom this time of year. It has been used by some American Indian medicine men during ceremonies.Tribune reporter Norma Wagner contributed to this story. Copyright 1998, The Salt Lake Tribune

Morbidity and Mortality Weekly Report (MMWR), January 27, 1995

Epidemiologic Notes and Reports Jimson Weed Poisoning -- Texas, New York, and California, 1994 Ingestion of Jimson weed (Datura stramonium), which contains the anticholinergics atropine and scopolamine, can cause serious illness or death. Sporadic incidents of intentional misuse have been reported throughout the United States, and clusters of poisonings have occurred among adolescents unaware of its potential adverse effects. This report describes incidents of Jimson weed poisoning that occurred in Texas, New York, and California during June-November 1994.

On June 19, 1994, the El Paso City-County Health and Environmental District was notified of two male adolescents (aged 16 and 17 years) who had died from D. stramonium intoxication. On June 18, the decedents and two other male adolescents had consumed tea brewed from a mixture of roots from a Jimson weed plant and alcoholic beverages, then fell asleep on the ground in the desert. Family and police found the decedents the following afternoon. The other two adolescents reported drinking only small amounts of the tea: one experienced hallucinations; the other had no signs or symptoms. Neither was treated, nor were biologic specimens collected. Screening of a toxicologic postmortem blood sample from one decedent detected atropine (55 ng/mL) and a blood alcohol concentration (BAC) of 0.03 g/dL (in Texas, intoxication is defined as a BAC greater than or equal to 0.1 g/dL). Analysis of the tea identified atropine, ethanol, and scopolamine.
New York

On the morning of October 9, 1994, an 18-year-old man from Long Island was brought to an emergency department (ED) by his mother after she found him in his bedroom unclothed and hallucinating. Reports from friends indicated he had ingested 50 Jimson weed seeds and had used controlled substances (i.e., cocaine, "ecstacy," and marijuana) at a party the previous night. On evaluation, the patient was hallucinating and had fully dilated pupils, dry mouth, and decreased bowel sounds. He became progressively agitated and was sedated with intravenous diazepam and alprazolam. Hallucinations continued for 36 hours. On October 11, he was discharged for psychiatric counseling. He had a history of chronic substance abuse.

During October 8-November 15, a regional poison-control center was contacted about this case and for information about 13 other identified cases of Jimson weed intoxication. The mean age of the 14 patients was 16.8 years (range: 14-21 years), and eight were male. In the five incidents for which quantity of Jimson weed exposure was reported, ingestion ranged from 30 to 50 seeds per person. Manifestations included visual hallucinations (12 persons), mydriasis (10), tachycardia (six), dry mouth (five), agitation (four), nausea and vomiting (four), incoherence (three), disorientation (three), auditory hallucinations (two), combativeness (two), decreased bowel sounds (two), slurred speech (two), urinary retention (one), and hypertension (one). Four patients were treated and released from EDs, six were hospitalized, three were admitted to an intensive-care unit (ICU), and one refused medical care. Five of these patients were treated with activated charcoal, one was administered gastric lavage, and none received physostigmine.

On October 22, 1994, two male and four female adolescents (aged 15-17 years) with a history of drinking Jimson weed tea were transported to an ED. Two persons were discharged from the ED; four were admitted to the ICU because of symptoms that included headache, fatigue, disorientation, fixed or sluggish dilated pupils, tachycardia (heart rates greater than 120 beats per minute), and hallucinations. These four patients were monitored with electrocardiograms, treated with physostigmine and activated charcoal, and discharged on October 23. The Los Angeles County Forestry Division reported that fires in the Los Angeles area may have promoted regrowth of Jimson weed in defoliated areas.

Reported by: DM Perrotta, PhD, Bur of Epidemiology, Environmental Epidemiologist, Texas Dept of Health; LN Nickey, MD, El Paso City-County Health and Environmental District, El Paso. M Raid, T Caraccio, PharmD, HC Mofenson, MD, Winthrop Univ Hospital, Long Island Regional Poison Control Center, New York; C Waters, Injury Control Program, D Morse, MD, State Epidemiologist, New York State Dept of Health. AM Osorio, MD, S Hoshiko, MPH, Div of Environmental and Occupational Disease Control, GW Rutherford, III, MD, State Epidemiologist, California State Dept of Health Svcs. Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note: D. stramonium grows throughout the United States and, historically, was used by American Indians for medicinal and religious purposes. All parts of the Jimson weed plant are poisonous, containing the alkaloids atropine, hyoscyamine, and scopolamine. Jimson weed--also known as thorn apple, angel's trumpet, and Jamestown weed (because the first record of physical symptoms following ingestion occurred in Jamestown, Virginia, in 1676 [1])--is a member of the nightshade family. The toxicity of Jimson weed varies by year, between plants, and among different leaves on the same plant. Although all parts of the plant are toxic, the highest concentrations of anticholinergic occur in the seeds (equivalent to 0.1 mg of atropine per seed). The estimated lethal doses of atropine and scopolamine in adults are greater than or equal to 10 mg and greater than 2-4 mg, respectively (1,2).

Symptoms of Jimson weed toxicity usually occur within 30-60 minutes after ingestion and may continue for 24-48 hours because the alkaloids delay gastrointestinal motility. Ingestion of Jimson weed manifests as classic atropine poisoning. Initial manifestations include dry mucous membranes, thirst, difficulty swallowing and speaking, blurred vision, and photophobia, and may be followed by hyperthermia, confusion, agitation, combative behavior, hallucinations typically involving insects, urinary retention, seizures, and coma (3). Treatment consists of supportive care, gastrointestinal decontamination (i.e., emesis and/or activated charcoal), and physostigmine in severe cases (4).

In 1993, a total of 94,725 poisonings associated with toxic plants was reported in the United States. Although most cases of Jimson weed poisoning in the United States occur sporadically, increased incidence or clustering of cases may follow press and broadcast reports that heighten interest in--but do not emphasize the adverse effects of--Jimson weed ingestion. In 1993, the American Association of Poison Control Centers Toxic Exposure Surveillance System received 318 reports of Jimson weed exposure. Although the total number of reported exposures to Jimson weed did not rank among the 20 most frequently reported exposures to poisonous plants (5), telephone calls to poison-control centers about Jimson weed poisoning are more likely than those about other hallucinogens to prompt a need for medical care (6). Poisoning associated with Jimson weed can be prevented through education of health-care providers and by press and broadcast reports to the public that emphasize the health hazards of Jimson weed ingestion, but that reduce access to the plant by omitting detailed descriptions and drawings and photographs.
1. Shervette RE, Schydlower M, Lampe RM, Fearnow RG. Jimson "loco" weed abuse in adolescents. Pediatrics 1979;63:520-3.
2. Hooper RG, Conner CS, Rumack BH. Acute poisoning from over-the-counter sleep preparations. Journal of the American College of Emergency Physicians 1979;8:98-100.
3. Rumack BH. Anticholinergic poisonings: treatment with physostigmine. Pediatrics 1973;52: 449-51.
4. Vanderhoff ST, Mosser KH. Jimson weed toxicity: management of anticholinergic plant ingestion. Am Fam Physician 1992;46:526-30.
5. Litovitz TL, Clark LR, Soloway RA. The 1993 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1994;12:546-84.
6. Klein-Schwartz W, Oderda GM. Jimson weed intoxication in adolescents and young adults. Am J Dis Child 1984;138:737-9.

Morbidity and Mortality Weekly Report (MMWR) May 25, 1984 / 33(20);282-3
Datura Poisoning from Hamburger -- Canada

On October 18, 1983, after a husband and wife ate a meal of hamburger prepared at home, the husband collapsed, and the wife telephoned for an ambulance to take him to a local hospital. When the ambulance arrived, the wife also became unconscious. Examination of the home showed no carbon monoxide source. Within 24 hours, the couple regained consciousness and explained the circumstances of their illness.

In preparing the hamburger, the wife added what she thought was seasoning but later realized was seeds of Angels' Trumpets (Datura suaveolens) that had been drying above the stove for planting the next year. After removing most of the seeds from the cooked meat, the husband and wife ate one hamburger patty each. Less than 1 hour later, both began to hallucinate. Other symptoms were tachycardia and severe diarrhea. Both recovered and were discharged after 3 days of hospitalization. Reported in Canada Diseases Weekly Report 1984;10:45.
Editorial Note:

There are several species of Datura, and all are poisonous, containing high levels (0.25%-0.7%) of anticholinergic alkaloids, such as atropine, hyoscyamine, and scopolamine. Three species are widely distributed in North America, but only one, D. suaveolens, is cultivated as an ornamental flower. Poisoning through the accidental mixing of seeds into food has been previously but not recently reported (1). "Locoweed" teas made from other Datura species have been used intentionally to produce hallucinatory effects (2).

Typical findings in Datura poisoning include pupillary dilation, flushing, fever, amnesia, urinary retention, decreased salivation, and, in contrast to the cases reported here, decreased intestinal motility. In more severe poisoning, active hallucinations, extreme agitation, cardiac arrhythmias, convulsions, delirium, stupor, or coma may occur. Physostigmine, a reversible antiacetylcholinesterase agent, may be useful in treating patients with central and peripheral manifestations of anticholinergic crisis.
1.Riemann H, ed. Food-borne infections and intoxications. 1st ed. New York: Academic Press, 1969.
2.Goldfrank LR, ed. Toxicologic emergencies: a comprehensive handbook in problem solving. New York: Appleton-Century-Crofts, 1982.

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