DOI: 10.12890/2024_004381

Anticholinergic toxidrome due to thorn apple seed ingestion in an elderly couple

Authors

  • Pepijn van Gastel Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
  • Jildou N. Dijkstra Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
  • Mina A. Jacob Department of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
  • Jeroen A. Schouten Department of Intensive Care, Radboud University Medical Centre, Nijmegen, Netherlands
  • Bram Kok Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands

bram.kok@radboudumc.nl

Keywords

Anticholinergic toxidrome, physostigmine

Abstract

Introduction: Sudden onset of reduced consciousness, psychomotor agitation and mydriasis are all indicative of an anticholinergic toxidrome. It is important to note that numerous drugs, as well as certain herbs and plants, possess anticholinergic properties.
Case description: An 84-year-old female patient had sudden nocturnal onset of uncoordinated hand movements and altered mental status. Shortly after, the patient’s 83-year-old husband developed symptoms of dysarthria, gait ataxia, vertigo, and delirium.
Conclusion: Anticholinergic syndrome consists of a combination of central and peripheral anticholinergic symptoms. Physostigmine given intravenously resulted in rapid reversal of symptoms. Thorn apple seeds had been accidentally ingested and were identified as the cause.

View the entire article

Downloads

References

  1. Caulfield MP, Birdsall NJ. International Union of Pharmacology. XVII. Classification of muscarinic acetylcholine receptors. Pharmacol Rev 1998;50:279–290.
  2. Wang GS, Baker K, Ng P, Janis GC, Leonard J, Mistry RD, et al. A randomized trial comparing physostigmine vs lorazepam for treatment of antimuscarinic (anticholinergic) toxidrome. Clin Toxicol (Phila) 2021;59:698–704.
  3. Murray L, Little M, Pascu O, Hoggett K. Toxicology Handbook, Elsevier Australia 2015, p. 444-445.
  4. Dawson AH, Buckley NA. Pharmacological management of anticholinergic delirium – theory, evidence and practice. Br J Clin Pharmacol 2016;81:516–524.

Published

2024-03-28

Issue

Vol. 11 No. 4 (2024)

Categories

How to Cite

1.
van Gastel P, Dijkstra JN, Jacob MA, Schouten JA, Kok B. Anticholinergic toxidrome due to thorn apple seed ingestion in an elderly couple. EJCRIM [Internet]. 2024 Mar. 28 [cited 2026 Nov. 3];11(4). Available from: https://ejcrim.com/index.php/ejcrim/article/view/4381