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McCabe DJ. Clinical Effects from Ingestion of Lappaconitine, an Aconitum Alkaloid with Sodium Channel Blocking Effects. J Med Toxicol 2022; 18:243-247. [PMID: 35556222 DOI: 10.1007/s13181-022-00896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Daniel J McCabe
- Division of Medical Toxicology, Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA. .,Iowa Poison Control Center, Sioux City, IA, USA. .,Department of Emergency Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Agosti A, Bricchi S, Rovati F, Vancea Opris M, Ponzi DG, Mariani F, Morelli N, Magnacavallo A, Vercelli A, Poggiali E. A sabbath in the emergency room or a case of anticholinergic toxicity? EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 32-year-old Italian man admitted to our emergency room for visual disturbances with blurred vision, anisocoria and temporal headache suddenly occurred in absence of other neurological symptoms. A diagnosis of Datura stramoniuminduced anticholinergic toxicity was done. With our work, we want to highlight the importance of a meticulous clinical examination, including papillary diameter and reflexes, combined with a detailed history of the patient in the emergency room. Anticholinergic toxicity is a medical emergency. The diagnosis is always clinical, and it can represent a challenge for the emergency clinicians because it can mimic several neurological diseases, including acute stroke and seizures, but early diagnosis is crucial to avoid severe complications and management errors.
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Algradi AM, Liu Y, Yang BY, Kuang HX. Review on the genus Brugmansia: Traditional usage, phytochemistry, pharmacology, and toxicity. JOURNAL OF ETHNOPHARMACOLOGY 2021; 279:113910. [PMID: 33571613 DOI: 10.1016/j.jep.2021.113910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The genus Brugmansia belongs to the Solanaceae family and contains approximately 7-8 species distributed in America, Europe, Africa, and Asia. The genus Brugmansia plants are used in the traditional medicine of different parts of the world for the treatment of inflammations, rheumatic arthritis, wounds, skin infections, headache, asthma, colic, aches, and so on. AIM OF THE REVIEW To the best of our knowledge, this is the first review study that focuses on the phytochemistry, pharmacology, toxicity, and traditional uses of Brugmansia species in order to understand the link between the traditional uses, phytochemistry, and modern therapeutic uses, and provide a scientific fundamental for further research in the phytochemical and pharmacological activities of their species. MATERIALS AND METHODS The information reported in this study was retrieved from the scientific database such as ScienceDirect, PubMed, Springer, CNKI, Wiley, Google Scholar, and Baidu Scholar, up until May 2020. The key search word was "Brugmansia." Additionally, information was derived by search on the reference lists of included articles and Ph.D. dissertations. RESULTS As traditional uses, Brugmansia species are used against a wide range of diseases such as body pain, inflammatory conditions, skin infection, wound, and other diseases. Also, these species are used as a hallucinogen, protection from evil, and magical rituals. Phytochemical investigations have led to reporting approximately 189 chemical compounds in this genus. Among these components, tropane alkaloids, terpenes, and flavonoids are the most representative components of Brugmansia species. The plant extracts and chemical constituents of Brugmansia species exhibit a broad spectrum of biological and pharmacological activities, including anti-inflammatory, cytotoxic, antioxidant, antibacterial, antispasmodic, anti-asthmatic, antinociceptive, antiprotozoal activities, and so on. CONCLUSION This review summarized and analyzed the information of traditional uses, phytochemical, pharmacological activities, and toxicity of the genus Brugmansia plants, which show their species have interesting chemical constituents with different biological activities. The traditional uses of some species from this genus have been estimated by pharmacological activities, such as the anti-inflammatory, antispasmodic, antiasthma, antinociceptive, anti-addictive, and antiprotozoal activity. However, the traditional uses of many species have not been confirmed, also the secondary metabolites of the many species have not yet been determined and have never been pharmacologically estimated. Considerably more research is needed to assert the ethnopharmacological uses, determine the chemical constituents, toxicity, and pharmacological activities of the genus Brugmansia species. The present review will be helpful for further research in the phytochemistry and pharmacology of Brugmansia species.
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Affiliation(s)
- Adnan Mohammed Algradi
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, China
| | - Yan Liu
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, China
| | - Bing-You Yang
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, China.
| | - Hai-Xue Kuang
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, China.
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Chemical Compounds, Pharmacological and Toxicological Activity of Brugmansia suaveolens: A Review. PLANTS 2020; 9:plants9091161. [PMID: 32911850 PMCID: PMC7570077 DOI: 10.3390/plants9091161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
This study investigates updated information in different search engines on the distribution, phytochemistry, pharmacology, and toxicology of Brugmansia suaveolens (Solanaceae) using the extracts or chemical compounds at present. This plant has been used in traditional medicine in different cultures as a hallucinatory, analgesic, aphrodisiac, nematicide, sleep inducer, and muscle relaxant, as well as a treatment for rheumatism, asthma, and inflammation. The flowers, fruits, stems, and roots of the plant are used, and different chemical compounds have been identified, such as alkaloids, volatile compounds (mainly terpenes), coumarins, flavonoids, steroids, and hydrocarbons. The concentration of the different compounds varies according to the biotic and abiotic factors to which the plant is exposed. The toxic effect of the plant is mainly attributed to atropine and scopolamine, their averages in the flowers are 0.79 ± 0.03 and 0.72 ± 0.05 mg/g of dry plant, respectively. Pharmacological studies have shown that an aqueous extract exhibits the antinociceptive effect, at doses of 100 and 300 mg/kg i.p. in mice. On the other hand, the ethanolic extract at 1000 mg/L, showed a nematocidal activity in vitro of 64% against Meloidogyne incognita in 72 h. Likewise, it showed a 100% larvicidal activity at 12.5 mg/L against Ancylostoma spp. In another study, the lethal activity of shrimp in brine from an ethanolic extract showed an LC50 of 106 µg/mL at double serial concentrations of 1000-0 (µg/mL). Although there are pharmacological and phytochemical studies in the plant, they are still scarce, which has potential for the examination of the biological activity of the more than one hundred compounds that have been reported, many of which have not been evaluated.
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Fatur K, Kreft S. Common anticholinergic solanaceaous plants of temperate Europe - A review of intoxications from the literature (1966–2018). Toxicon 2020; 177:52-88. [DOI: 10.1016/j.toxicon.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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[Acute intoxications: markers for screening, diagnosis and therapy monitoring]. Med Klin Intensivmed Notfmed 2019; 114:302-312. [PMID: 30944942 DOI: 10.1007/s00063-019-0566-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/21/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
Acute poisonings account for a significant proportion of the patient population presenting to intensive care units, whereby mixed drug overdoses and prescription drug overdoses predominate. The aim of this article was to describe indications for screening, diagnosis and therapy monitoring in acute overdoses in the intensive care unit. To conduct this work, a literature search was carried out and a review was written based on guidelines, case reports, expert opinions and scientific publications. Toxidromes are a useful tool for classification of clinical characteristics when the causative agent is initially unknown. Especially in critical care medicine, identifying and quantifying of the causative toxin by enzyme immunoassays, chromatography and mass spectrometry should be attempted. Intensive care treatment of patients with acute overdoses includes not only monitoring and support of vital functions but also methods for primary and secondary elimination of toxins. The indication for the use of extracorporeal procedures should be carefully evaluated and the method should be chosen based on protein binding and molecular size. Lipid emulsion therapy, high-dose insulin euglycaemia therapy and hyperbaric oxygenation are also increasingly used.
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Doan UV, Wu ML, Phua DH, Mendez Rojas B, Yang CC. Datura and Brugmansia plants related antimuscarinic toxicity: an analysis of poisoning cases reported to the Taiwan poison control center. Clin Toxicol (Phila) 2018; 57:246-253. [PMID: 30522351 DOI: 10.1080/15563650.2018.1513527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Uyen Vy Doan
- International Health Program, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Ling Wu
- Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dong-Haur Phua
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bomar Mendez Rojas
- Centro de Investigaciones e Intervenciones en Salud, Leon, Nicaragua
- Pan American Health Organization, Tegucigalpa, Honduras
| | - Chen-Chang Yang
- Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Versiani MA, Ahmed SK, Ikram A, Ali ST, Yasmeen K, Faizi S. Chemical constituents and biological activities of Adenium obesum (Forsk.) Roem. et Schult. Chem Biodivers 2014; 11:171-80. [PMID: 24591309 DOI: 10.1002/cbdv.201200254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Muhammad Ali Versiani
- Department of Chemistry, Federal Urdu University of Arts, Sciences and Technology, Gulshan-e-Iqbal Campus, Karachi-75300, Pakistan (phone: +92-21-99244141-146, fax: +92-21-99244272).
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Abstract
The critical care physician is often called to care for poisoned patients. This article reviews the general approach to the poisoned patient, specifically focusing on the utility of the toxidrome. A toxidrome is a constellation of findings, either from the physical examination or from ancillary testing, which may result from any poison. There are numerous toxidromes defined in the medical literature. This article focuses on the more common toxidromes described in clinical toxicology. Although these toxidromes can aid the clinician in narrowing the differential diagnosis, care must be exercised to realize the exceptions and limitations associated with each.
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Affiliation(s)
- Christopher P Holstege
- Division of Medical Toxicology, Department of Emergency Medicine, Blue Ridge Poison Center, University of Virginia Health System, University of Virginia School of Medicine, PO Box 800774, Charlottesville, VA 22908-0774, USA.
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Levine M, Ruha AM, Graeme K, Brooks DE, Canning J, Curry SC. Toxicology in the ICU: part 3: natural toxins. Chest 2011; 140:1357-1370. [PMID: 22045882 DOI: 10.1378/chest.11-0295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
This is the third article of a three-part series that reviews the care of poisoned patients in the ICU. This article focuses on natural toxins, such as heavy metals and those produced by plants, mushrooms, arthropods, and snakes. The first article discussed the general approach to the patient, including laboratory testing; the second article focused on specific toxic agents, grouped into categories.
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Affiliation(s)
- Michael Levine
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ.
| | - Anne-Michelle Ruha
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
| | - Kim Graeme
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ; Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, CA
| | - Daniel E Brooks
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
| | - Joshua Canning
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
| | - Steven C Curry
- Department of Medical Toxicology, Banner Good Samaritan Medical Center, Phoenix, AZ
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Melia azedarach como ejemplo de intoxicación accidental evitable. Med Clin (Barc) 2011; 137:519-20. [DOI: 10.1016/j.medcli.2011.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/07/2011] [Accepted: 01/11/2011] [Indexed: 11/22/2022]
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Fuchs J, Rauber-Lüthy C, Kupferschmidt H, Kupper J, Kullak-Ublick GA, Ceschi A. Acute plant poisoning: analysis of clinical features and circumstances of exposure. Clin Toxicol (Phila) 2011; 49:671-80. [PMID: 21809910 DOI: 10.3109/15563650.2011.597034] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Human contact with potentially toxic plants, which may occur through abuse or by accident or attempted suicide, is frequent and sometimes results in clinically significant toxicity. OBJECTIVE The aim of the present study was to identify which plants may lead to severe poisoning, and to define the clinical relevance of plant toxicity for humans in Switzerland. METHODS We analyzed 42,193 cases of human plant exposure and 255 acute moderate, severe, and lethal poisonings, which were reported to the Swiss Toxicological Information Centre between January 1995 and December 2009. RESULTS Plant contact was rarely responsible for serious poisonings. Lethal intoxications were extremely rare and were caused by plants with cardiotoxic (Taxus baccata) or mitosis-inhibiting (Colchicum autumnale) properties. CONCLUSIONS Most often, plant contact was accidental and patients remained asymptomatic or developed mild symptoms, which fully resolved within a short time.
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Affiliation(s)
- Joan Fuchs
- Swiss Toxicological Information Centre, Zurich, Switzerland
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Su YJ, Lai YC. Treat the patient by the recognized toxidrome when the ingested herbal juice is non-toxic. Int J Emerg Med 2010. [PMID: 20606823 DOI: 10.1007/s12245-010-0173-0.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This is the case of 63-year-old mother and her 35-year-old daughter who drank herbal juice (Rhizoma Dioscoreae Nipponicae and Ficus formosana Maxim) and then developed diarrhea, cold sweating, and myoclonus. On physical examination, the mother had a normal consciousness level, a normal respiratory rate, and bilateral miosis. After the administration of 2 g of pralidoxime (PAM) and 0.5 mg of atropine, the mother felt better. The daughter only had mild symptoms of sweating and vomiting before arrival at the emergency department (ED).The poison center of our hospital was consulted, and they assured us that the herbs ingested were all non-toxic. In conclusion, the majority of emergency physicians are not familiar with herbal medicines and plants. In this instance, however, it was more important to apply appropriate early management according to the toxidrome rather than to recognize what kind of herb had been ingested.
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Su YJ, Lai YC. Treat the patient by the recognized toxidrome when the ingested herbal juice is non-toxic. Int J Emerg Med 2010; 3:133-4. [PMID: 20606823 PMCID: PMC2885264 DOI: 10.1007/s12245-010-0173-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 02/25/2010] [Indexed: 02/07/2023] Open
Abstract
This is the case of 63-year-old mother and her 35-year-old daughter who drank herbal juice (Rhizoma Dioscoreae Nipponicae and Ficus formosana Maxim) and then developed diarrhea, cold sweating, and myoclonus. On physical examination, the mother had a normal consciousness level, a normal respiratory rate, and bilateral miosis. After the administration of 2 g of pralidoxime (PAM) and 0.5 mg of atropine, the mother felt better. The daughter only had mild symptoms of sweating and vomiting before arrival at the emergency department (ED).The poison center of our hospital was consulted, and they assured us that the herbs ingested were all non-toxic. In conclusion, the majority of emergency physicians are not familiar with herbal medicines and plants. In this instance, however, it was more important to apply appropriate early management according to the toxidrome rather than to recognize what kind of herb had been ingested.
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Affiliation(s)
- Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, North Chung-Shan Rd., 10449 Taipei, Taiwan
- Mackay Medicine, Nursing and Management College, No. 92, Shengjing Rd., Beitou District, Taipei, 112 Taiwan
- Research Center for Biomedical Implants and Microsurgery Devices, Taipei Medical University, 110 Taipei, Taiwan
| | - Yen-Chun Lai
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, 110 Taipei, Taiwan
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