Unknowing ingestion of Brugmansia suaveolens leaves presenting with signs of anticholinergic toxicity: a case report

K P Jayawickreme,K V C Janaka,S A S P Subasinghe

doi:10.1186/s13256-019-2250-1

Abstract

BackgroundBrugmansia suaveolens is the commonest species under the Solanacea (“Angels Trumpet” in English; “Attana” in Sinhalese) plant family in Sri Lanka. It contains alkaloids like scopolamine, atropine and hyoscyamine which can cause an anticholinergic toxindrome. There have been a few reported cases of accidental ingestion of Brugmansia seeds among children, seeds being the most toxic part, but no such reported cases of Brugmansia leaves poisoning among adults.Case presentationA 60-year-old-female Sinhalese presented with acute confusion, delirium, and agitation. She had ingested a herbal drink made from leaves of an unknown plant from her garden prior to onset of symptoms. She had urinary retention, mydriasis and sinus tachycardia. She was managed supportively with activated charcoal and hydration and the delirium completely resolved within 15 hours. The presented unkown plant leaves were identified as Brugmansia suaveolens.ConclusionAlthough seeds are the most toxic plant part in most cases of Brugmansia poisoning, leaves also have a significant degree of toxicity. It is important that medical professionals promptly recognize the features of anticholinergic syndrome, and have a high index to suspect Brugmansia poisoning and start prompt treatment. It is also important to improve awareness of toxic plants among the general community to prevent toxicities and fatalities.

Highlights

Self-poisoning carries a high mortality and morbidity in developing countries like Sri Lanka
A study in the National hospital of Sri Lanka which assessed the pattern in the western province showed 68% of poisoning cases to be due to medicinal drugs, 21% due to pesticides, and 6.28% due to orleander poisoning [3]. 2.5% of poisoning cases were due to plant poisoning, and yellow orleander poisoning being the commonest accounting for 17% cases in Sri Lanka [4, 5]
Since the rarity of presentation due to this rare toxic plant leaf, the knowledge of it’s toxicity may be poor among the population, and doctors may not have a high index of suspicion in identifying such cases

Summary

Conclusion

Seeds are the most toxic plant part in most cases of Brugmansia and Datura poisoning, it’s leaves have significant toxicity. It is important that medical professionals promptly recognize the features of anticholinergic syndrome in patients who present following unknown plant poisoning, and have a high index to suspect Brugmansia or Datura poisoning and start prompt treatment to improve outcome. It is important to improve awareness of toxic plants among the general community to prevent toxicities and fatalities

Introduction

Findings

Discussion