L8: Plant Poisons Flashcards
Source of Atropine
Datura plant which is known also as thorn apple.
Two otber plant families haye the same active ingredients:
- Atropa belladona plant & Hyoscyamus muticus plant.
in which part of datura plant is Atropine found?
Every part of Datura plants (leaves, fruits, flowers and seeds)
what are the alkaloids found in datura plant?
- contains three alkaloids (Atropine, hyoscine and hyoscyamine).
- The three alkaloids together referred to as (Belladona alkaloids).
where is the highest concentration of alkaloids found in datura plants?
Seeds
Toxic action of Atropine
Characteristcs of Hyoscyamine
- similar to atropine but more potent.
Characters of Hyoscine
- similar to atropine but it is a CNS depressant from the start
- (No initial stimulatory phase) even at therapeutic doses.
Peripheral and central manifestations of atropine start ….. after ingestion, Can last for ……..
- Peripheral and central manifestations start 30-60 min after ingestion, Can last for 24-48 hours.
CP of Atropine Toxicity
Peripheral effects manifestations:
- Dry as a Bone
- Red as a beet
- hot as a hare
- Blind as a bat
- Flappy as a bird
- Urinary retention and decreased intestinal sounds
Central effects manifestations
- Initial stimulatory stage
- Second inhibitory stage (depressant)
Dry as a bone Atropine Toxicity
Due to inhibition of salivation:
- Dryness of mouth and throat.
- Difficulty in swallowing (dysphagia) and speech (dysphonia).
- Bitter taste in the mouth.
Red as a beet Atropine Toxicity
- Dilatation of cutaneous blood vessels causes atropine flush: Dry, hot and red flushed face
Hot as a hare Atropine Toxicity
- Body temperature is raised (atropine fever)
Where the skin is hot and dry due to:
- Inhibition of sweat secretion.
- Stimulation of heat regulating center (central).
Blind as a bat Atropine Toxicity
- Pupils are dilated and fixed (insensitive to light) leading to blurred
- The power of accommodation is paralyzed
Flappy as a bird Atropine Toxicity
- Tachycardia (120-140 /min)
- Hyperpnea.
Central manifestations of Atropine Toxicity
- Initial stimulatory stage
- Second inhibitory stage (depressant)
Initial stimulatory stage of Atropine Toxicity
Staggering unsteady gait like a drunker
Irritability, restlessness and mental confusion
- (The mind is affected early).
Purposeless movements (occupational delirium) (Mad as a Hen):
- The person appears to grasp at imaginary objects, e.g., rolling a cigarette, threading a needle.
- This usually accompanied by mutters in distinct words, visual and auditory hallucinations as well as failure to recognize relatives.
Convulsions are seen in severe cases.
Second inhibitory stage of Atropine Toxicity
The patient due to cortical depression becomes drowsy
- then passes into stupor
- followed by coma and death due to respiratory center paralysis.
DDx in Atropine Toxicity
- Heat stroke
- Alcohol Poisoning
Investigations in Atropine Toxicity
Compare between Atropine Toxicity & Alcohol Toxicity
TTT aspects of Atropine Toxicity
- Emergency
- Decontamination
- Antidotes
- Enhanced Elimination
- Symptomatic TTT
Emergency TTT of Atropine Toxicity
- Care ABCDE
- Treat coma and convulsions if occur.
- Monitor ECG, blood pressure and temperature.
Decontamination in Atropine Toxicity
- Gastric lavage
- Activated Charcoal
Gastric Labage in Atropine Toxicity
- To remove remnants of crushed seeds.
Activated Charcoal in Atropine Toxicity
- Give with cathartic even after 24 hours from ingestion of datura seeds (intestinal motility is decreased),
Antidote in Atropine Toxicity
Physostigmine:
Indications of Physostigmine
Indicated only in severe toxicity
(Eg, severe hypertension, severe delirium, arrhythmia, coma and convulsion).
Mechanism of Physostigmine
- It antagonizes peripheral and central effects as it crosses BBB
SE of Physostigmine
Patient needs monitoring as it may cause seizures, bradycardia or asystole.
Pilocarpine, Pyridostigmine & Neostigmine in Atropine Toxicity
- They are not effective in treating central atropine toxicity as not pass BBB.
- Neostigmine can be used for treating anticholinergic-induced ileus.
Enhanced Elimination in Atropine Toxicity
Symptomatic TTT in Atropine Toxicity
Cultivation of Opiates in egypt
forbidden by law in Egypt
Sources of Opiates
- Opiates are a group of naturally occurring compounds that present in “Crude opium”
- which is obtained from capsule of “Papaver Somniferum” plant (Poppy or Khash Khash).
what do Opiates contain?
- Actually, opium contains more than 20 alkaloids (e.g., Morphine, Codeine, Narceine, Narcotine, Papaverine, Thebaine)
- but it owes its action chiefly to its alkaloid morphine
what do Opiates inhibit?
Toxic action of Opiates
- Inhibition
- Stimulation
- Other Actions
What do Opiates stimulate?
Other actions of Opiates
Onset of manifestations in Opiates Toxicity
½-1 hour (if morphine ingested)
Within few minutes (if injected).
What causes morphine coma?
With high doses of opiods
CP of Opiates Toxicity
Morphine coma
Describe morphine coma
DDx of Opiates Toxicity
Dx of Opiates Toxicity
Investigations in Opiates Toxicity
TTT aspects of Opiates Toxicity
- Emergency and supportive measures
- Antidotes
- Decontamination
- Enhanced Elimination
- Symptomatic treatment
Emergency TTT of Opiates Toxicity
- Maintain an open airway and administer supplemental oxygen.
- Assist ventilation if necessary
- Continuous cardiac monitoring and treatment of hypotension.
- IV diazepam for controlling resistant soizures.
Antidote of Opiates Toxicity
Naloxone (N-Allyloxymorphine)
Indications of Naloxone
- It is pure opioid antagonist
- It is a diagnostic and therapeutic antidote
Dose of Naloxone
0.1-0.4 mg IV.
- Repeat doses every 2-3 minutes, if there is no response, up to a total dose of 10-20 mg.
Titrable dose of Naloxone
- If an opioid overdose is strongly suspected.
- “Titrate the dose to reach the desirable effect → without induction of withdrawal manifestation in addict”
Cautions during adminstration of Naloxone
- The duration of effect of naloxone (1-2 hours) is shorter than that of many opioids.
- If repeated dosing is required, the patient should be admitted to intensive care unit (ICU) under observation.
Nalmefene as an antidote for Opiate Toxicity
may be substituted for naloxone if prolonged antagonism is desired duration of action is (3-5h).
Decontamination in Opiate Toxicity
Is enhanced eliminatation effective in Opiate Toxicity?
Sources of Cannabis
- Indian hemp plant “Cannabis sativa plant”
- All parts of the plant are poisonous.
- Its cultivation is prohibited in Egypt.
Symptomatic TTT in Opiate Toxicity
Hypothermia: Maintain body warmth by blankets and warm water bottles.
Cannabis names
Toxic action of Cannabis
CP of Cannabis Toxicity
Dx of Cannabis Toxicity
History: of addiction and or cannabis smoking.
Clinical presentation: of previous typical physical findings.
Investigations in Cannabis Toxicity
Toxicological Screen:
For cannabinoid metabolites may be detected in the urine up to
- Several days after a single acute exposure
- Weeks after chronic THC exposure
Emergency TTT in Cannabis Toxicity
antidote in Cannabis Toxicity
There is no specific antidote.
Decontamination in Cannabis Toxicity
Gastric lavage & Activated charcoal.
Enhanced Elimination in Cannabis Toxicity
No Role
“Due to large volume of distribution of cannabinoids”.
Symptomatic TTT in Cannabis Toxicity
Psychiatric consultation for exaggerated psychic illness
