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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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Maurya VK, Kumar S, Kabir R, Shrivastava G, Shanker K, Nayak D, Khurana A, Manchanda RK, Gadugu S, Kar SK, Verma AK, Saxena SK. Dark Classics in Chemical Neuroscience: An Evidence-Based Systematic Review of Belladonna. ACS Chem Neurosci 2020; 11:3937-3954. [PMID: 32662978 DOI: 10.1021/acschemneuro.0c00413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Belladonna has diverse pharmacotherapeutic properties with a shadowy history of beauty, life, and death. Alkaloids present in belladonna have anti-inflammatory, anticholinergic, antispasmodic, mydriatic, analgesic, anticonvulsant, and antimicrobial activities, which makes it widely applicable for the treatment of various diseases. However, because of its associated toxicity, the medicinal use of belladonna is debatable. Therefore, an evidence-based systematic review was planned to elucidate the pharmacotherapeutic potential of belladonna. A comprehensive literature search was performed in PubMed, MEDLINE, the Cochrane database, Embase, and ClinicalTrials.gov using the keywords "belladonna", "belladonna and clinical trials", and "safety and efficacy of belladonna". Articles published from 1965 to 2020 showing the efficacy of belladonna in diverse clinical conditions are included. The quality of evidence was generated using the GRADE approach, and 20 studies involving 2302 patients were included for the systematic review. Our analyses suggest that belladonna treatment appears to be safe and effective in various disease conditions, including acute encephalitis syndrome, urethral stent pain, myocardial ischemia injury, airway obstructions during sleep in infants, climacteric complaints, irritable bowel syndrome, and throbbing headache. However, better understanding of the dosage and the toxicity of tropane alkaloids of belladonna could make it an efficient remedy for treating diverse medical conditions.
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Affiliation(s)
- Vimal K. Maurya
- Centre for Advanced Research, Faculty of Medicine, King George’s Medical University, Lucknow 226003, India
| | - Swatantra Kumar
- Centre for Advanced Research, Faculty of Medicine, King George’s Medical University, Lucknow 226003, India
| | - Russell Kabir
- School of Allied Health, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, United Kingdom
| | - Gaurav Shrivastava
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland 20852, United States
| | - Karuna Shanker
- CSIR-Central Institute of Medicinal and Aromatic Plants, Lucknow 226015, India
| | - Debadatta Nayak
- CCRH, Ministry of Ayush, Government of India, New Delhi 110058, India
| | - Anil Khurana
- CCRH, Ministry of Ayush, Government of India, New Delhi 110058, India
| | - Raj K Manchanda
- CCRH, Ministry of Ayush, Government of India, New Delhi 110058, India
| | - Srinivasulu Gadugu
- Department of Medicine, JSPS Government Medical College, Hyderabad 500013, India
| | - Sujita K. Kar
- Department of Psychiatry, King George’s Medical University, Lucknow 226003, India
| | - Anoop K. Verma
- Department of Forensic Medicine and Toxicology, King George’s Medical University, Lucknow 226003, India
| | - Shailendra K. Saxena
- Centre for Advanced Research, Faculty of Medicine, King George’s Medical University, Lucknow 226003, India
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Mladěnka P, Applová L, Patočka J, Costa VM, Remiao F, Pourová J, Mladěnka A, Karlíčková J, Jahodář L, Vopršalová M, Varner KJ, Štěrba M. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev 2018; 38:1332-1403. [PMID: 29315692 PMCID: PMC6033155 DOI: 10.1002/med.21476] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/20/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022]
Abstract
Cardiovascular diseases are a leading cause of morbidity and mortality in most developed countries of the world. Pharmaceuticals, illicit drugs, and toxins can significantly contribute to the overall cardiovascular burden and thus deserve attention. The present article is a systematic overview of drugs that may induce distinct cardiovascular toxicity. The compounds are classified into agents that have significant effects on the heart, blood vessels, or both. The mechanism(s) of toxic action are discussed and treatment modalities are briefly mentioned in relevant cases. Due to the large number of clinically relevant compounds discussed, this article could be of interest to a broad audience including pharmacologists and toxicologists, pharmacists, physicians, and medicinal chemists. Particular emphasis is given to clinically relevant topics including the cardiovascular toxicity of illicit sympathomimetic drugs (e.g., cocaine, amphetamines, cathinones), drugs that prolong the QT interval, antidysrhythmic drugs, digoxin and other cardioactive steroids, beta-blockers, calcium channel blockers, female hormones, nonsteroidal anti-inflammatory, and anticancer compounds encompassing anthracyclines and novel targeted therapy interfering with the HER2 or the vascular endothelial growth factor pathway.
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Affiliation(s)
- Přemysl Mladěnka
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Lenka Applová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Jiří Patočka
- Department of Radiology and Toxicology, Faculty of Health and Social StudiesUniversity of South BohemiaČeské BudějoviceCzech Republic
- Biomedical Research CentreUniversity HospitalHradec KraloveCzech Republic
| | - Vera Marisa Costa
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Fernando Remiao
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of PharmacyUniversity of PortoPortoPortugal
| | - Jana Pourová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Aleš Mladěnka
- Oncogynaecologic Center, Department of Gynecology and ObstetricsUniversity HospitalOstravaCzech Republic
| | - Jana Karlíčková
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Luděk Jahodář
- Department of Pharmaceutical Botany and Ecology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Marie Vopršalová
- Department of Pharmacology and Toxicology, Faculty of Pharmacy in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
| | - Kurt J. Varner
- Department of PharmacologyLouisiana State University Health Sciences CenterNew OrleansLAUSA
| | - Martin Štěrba
- Department of Pharmacology, Faculty of Medicine in Hradec KrálovéCharles UniversityHradec KrálovéCzech Republic
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Kwakye GF, Jiménez J, Jiménez JA, Aschner M. Atropa belladonna neurotoxicity: Implications to neurological disorders. Food Chem Toxicol 2018; 116:346-353. [DOI: 10.1016/j.fct.2018.04.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 12/24/2022]
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Chadwick A, Ash A, Day J, Borthwick M. Accidental overdose in the deep shade of night: a warning on the assumed safety of 'natural substances'. BMJ Case Rep 2015; 2015:bcr2015209333. [PMID: 26543025 PMCID: PMC4654174 DOI: 10.1136/bcr-2015-209333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 11/03/2022] Open
Abstract
There is an increasing use of herbal remedies and medicines, with a commonly held belief that natural substances are safe. We present the case of a 50-year-old woman who was a trained herbalist and had purchased an 'Atropa belladonna (deadly nightshade) preparation'. Attempting to combat her insomnia, late one evening she deliberately ingested a small portion of this, approximately 50 mL. Unintentionally, this was equivalent to a very large (15 mg) dose of atropine and she presented in an acute anticholinergic syndrome (confused, tachycardic and hypertensive) to our accident and emergency department. She received supportive management in our intensive treatment unit including mechanical ventilation. Fortunately, there were no long-term sequelae from this episode. However, this dramatic clinical presentation does highlight the potential dangers posed by herbal remedies. Furthermore, this case provides clinicians with an important insight into potentially dangerous products available legally within the UK. To help clinicians' understanding of this our discussion explains the manufacture and 'dosing' of the A. belladonna preparation.
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Affiliation(s)
- Andrew Chadwick
- Adult Intensive Care Department, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Abigail Ash
- Adult Intensive Care Department, Oxford University Hospitals NHS Trust, Oxford, UK
| | - James Day
- Adult Intensive Care Department, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Mark Borthwick
- Adult Intensive Care Department, Oxford University Hospitals NHS Trust, Oxford, UK
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Abstract
A young female was admitted in medical emergency room with fever, tachycardia and breathing difficulty. A provisional diagnosis of septicemia was made and empirical antibiotics were started. The patient required intubation and assisted ventilation. The patient recovered within 72 hours completely except bilateral mid-dilated fixed pupils. Atropine was not administered in the hospital. All blood investigations and infection screening tests were negative. After detailed history, examination and discussions, atropine poisoning was suspected which could explain all the signs and symptoms of the patient. This highlights the examination of pupillary reflexes in emergency room and meticulous clinical examination.
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Hogewind BF, Coebergh JAF, Gritters-van den Oever NC, de Wolf MWP, van der Wielen GJ. The ocular disease of Aristodemus and Eurytus 480 BC: diagnostic considerations. Int Ophthalmol 2013; 33:107-9. [PMID: 23404726 DOI: 10.1007/s10792-012-9638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE In the historic description of Herodotus on the battle of Thermopylae at 480 BC two formerly healthy warriors suffer from "ophthalmia". The purpose of this study is to assess the possible aetiologies of this disease. DESIGN We studied Herodotus' description in translation and offer a differential diagnosis. RESULTS From the text we deduced that the "ophthalmia" was a condition in two physically fit males with a bilateral decreased or distorted vision, lasting longer than an hour, with an acute or subacute onset in Ancient Greece. The condition ultimately went into remission in one of the two patients, whereas the other subject deceased in combat not long after the onset of the disease, still suffering from the disease. The differential diagnosis consists of (1) anticholinergic syndrome secondary to an intoxication with the berries of the plant Atropa belladonna, (2) automutilation and (3) psychogenic loss of visual acuity. CONCLUSION It is impossible to assess the ultimate cause of the "opthalmia" after 2500 years, but we suggest the anticholinergic syndrome by intoxication with Atropa belladonna is the most likely.
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[Deadly nightshade (Atropa belladonna) intoxication in a 2-year-old child]. Arch Pediatr 2010; 18:186-8. [PMID: 21194906 DOI: 10.1016/j.arcped.2010.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 11/25/2010] [Indexed: 11/24/2022]
Abstract
Plant intoxications account for 5% of all intoxication cases according to French anti-poison centers. We report an uncommon case of intoxication with deadly nightshade (Atropa belladonna) in a 2-year-old child. The child presented at the ER with an atropinic syndrome, both central and peripheral, after ingestion of wild berries a few hours before. The fruit and leaves brought in by the mother allowed the anti-poison center to identify belladonna, in agreement with clinical findings. The child was kept in the intensive care unit for 48 h and progression was favorable with symptomatic treatment.
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