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Lahoud C, Hanna NG, Jalkh A, Azar G. Acute Bilateral Fixed Mydriasis Caused by Lupini Bean Intoxication. Wilderness Environ Med 2021; 32:217-220. [PMID: 33863613 DOI: 10.1016/j.wem.2021.01.003] [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: 05/12/2020] [Revised: 12/03/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Lupini beans are legume seeds of the genus Lupinus, consumed in many parts of the world. The main species are Lupinus mutabilis, Lupius angustifolius, and Lupinus albus. The latter is commonly eaten as a snack in Mediterranean countries. The beans are very rich in alkaloids, which give them a bitter taste. One of these alkaloids was shown to cause anticholinergic effects. Lupini beans, if improperly prepared, can cause toxicity manifesting as an anticholinergic syndrome. We present the case of a 50-y-old woman who presented with bilateral mydriasis, mouth dryness, and anxiety. We confirmed that the patient consumed partially debittered lupini beans a few hours before presentation. The rest of her physical and ophthalmic examination results were within normal limits. Her symptoms resolved without therapy within 12 h from presentation and were attributed to ingestion of incorrectly prepared lupine seeds.
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Affiliation(s)
- Corinne Lahoud
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Usek, Lebanon; Eye and Ear Hospital International, Naccache, Lebanon.
| | - Najib-Georges Hanna
- Clinical Fellow in the Faculty of Health Sciences, Department of Surgery, Division of Ophthalmology, Ophthalmic Plastic Reconstructive and Orbital Surgery, McMaster University, Ontario, Canada
| | | | - Georges Azar
- Hôpital Fondation Adolphe de Rothschild, service du Professeur Cochereau, Paris, France
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Wang GS, Baker K, Ng P, Janis GC, Leonard J, Mistry RD, Heard K. A randomized trial comparing physostigmine vs lorazepam for treatment of antimuscarinic (anticholinergic) toxidrome. Clin Toxicol (Phila) 2020; 59:698-704. [DOI: 10.1080/15563650.2020.1854281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
| | - Keith Baker
- Departments of Emergency Medicine and Medical Toxicology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Patrick Ng
- En route Care Research Center, Lackland AFB, San Antonio, TX, USA
| | - Gregory C. Janis
- MedTox Laboratories, Laboratory Corporation of America Holdings, Saint Paul, MN, USA
| | - Jan Leonard
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
| | - Rakesh D. Mistry
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
| | - Kennon Heard
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, University of Colorado Hospital, Aurora, CO, USA
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Grenga PN, Schult RF, Wiegand TJ. Physostigmine use in clozapine intoxication from adulterated heroin: an atypical toxidrome with an effective antidote. TOXICOLOGY COMMUNICATIONS 2018. [DOI: 10.1080/24734306.2018.1472870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Paolo N. Grenga
- Department of Emergency Medicine, University of Rochester Strong Memorial Hospital, Rochester, NY, U.S.A
| | - Rachel F. Schult
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Timothy J. Wiegand
- URMC and Strong Memorial Hospital, Ruth A. Lawrence Poison and Drug Information Center, Rochester, NY, U.S.A
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Abstract
Adolescent substance abuse remains common, with almost a third of adolescents admitting to ethanol use, and a quarter admitting to illicit drug use. It is essential for pediatricians to regularly screen adolescent patients for substance use, because early initiation of drug use has been associated with physical, behavioral, and social health risks. Adolescents abuse what is common and readily available; this includes ethanol, over-the-counter products, marijuana, and inhalants. The most common and effective clinical treatments for significant toxicity from substances of abuse is symptomatic and supportive care including hemodynamic support, respiratory support, and sedation to control psychomotor agitation.
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Affiliation(s)
- George Sam Wang
- Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO.,Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health Hospital, Denver, CO.,Department of Emergency Medicine and Medical Toxicology, University of Colorado Anschutz Medical Campus, University Hospital, Aurora, CO
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Mohamed A, Alkhiyami D, Rahhal A, Del Castillo MJC, Pichad SM, Ahmad M. Procyclidine overdose induced central and peripheral anti-cholinergic toxicity. TOXICOLOGY COMMUNICATIONS 2018. [DOI: 10.1080/24734306.2018.1459109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Adham Mohamed
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ala Rahhal
- Pharmacy Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Sunil M. Pichad
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Muayad Ahmad
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
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Taylor CL, Taylor SF. Atropine autoinjector use as a suicidal gesture. J Emerg Med 2008; 34:397-400. [PMID: 17931821 DOI: 10.1016/j.jemermed.2007.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 11/28/2006] [Accepted: 02/11/2007] [Indexed: 05/25/2023]
Abstract
Atropine autoinjectors are used by the U.S. military as pre-hospital first-line therapy for nerve agent exposure. This case report examines the misuse of these devices in a suicide attempt. An anticholinergic toxidrome resulted from this misuse. The patient was successfully treated.
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Affiliation(s)
- Charles L Taylor
- Department of Emergency Medicine, Womack Army Medical Center, Fort Bragg, North Carolina, USA
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Litkey J, Dailey MW. Anticholinergic toxicity associated with the ingestion of lupini beans. Am J Emerg Med 2007; 25:215-7. [PMID: 17276821 DOI: 10.1016/j.ajem.2006.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 08/03/2006] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joanne Litkey
- Department of Emergency Medicine, Albany Medical Center, Albany, NY 12208, USA
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Di Grande A, Paradiso R, Amico S, Fulco G, Fantauzza B, Noto P. Anticholinergic toxicity associated with lupin seed ingestion: case report. Eur J Emerg Med 2004; 11:119-20. [PMID: 15028905 DOI: 10.1097/00063110-200404000-00014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a case of acute poisoning in a 51-year-old female patient who presented to the Emergency Department with weakness, anxiety, dry mouth, bilateral mydriasis and lid drop. In differential diagnosis, botulism, Guillain-Barré syndrome and myasthenia gravis were considered, as well as cerebral haematoma because of a cranial injury a week before. Symptoms, which resolved within 12 h without any therapy, were instead related to the ingestion of lupin seeds.
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Affiliation(s)
- Aulo Di Grande
- Unità Operativa di Medicina e Chirurgia d'Accettazione e d'Urgenza, Azienda Ospedaliera S. Elia, Caltanissetta, Italy.
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