; Jimsonweed Poisoning Associated with a Homemade Stew - Maryland, 2008
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Jimsonweed Poisoning Associated with a Homemade Stew - Maryland, 2008

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In the early morning hours of July 9, 2008, six adult family members were admitted to a hospital emergency department in Maryland with hallucinations, confusion, mydriasis, and tachycardia of approximately 3-4 hours duration. Approximately 4-5 hours earlier, all six family members had shared a meal of homemade stew and bread. A report that describes the poisoning incident, which resulted in six hospitalizations and the subsequent multidisciplinary investigation is presented. Results of the investigation show that the stew contained jimsonweed, a plant that has been associated with anticholinergic-type poisoning. A CDC editorial note is also presented.

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									                                      MMWR Morbidity and Mortality Weekly Report



         Jimsonweed Poisoning Associated with a Homemade Stew —
                             Maryland, 2008

          In the early morning hours of July 9, 2008, six       were awake and had altered mental status; complete
      adult family members were admitted to a hospital          history of meal preparation and food exposures could
      emergency department in Maryland with halluci-            not be obtained. Physical examinations revealed
      nations, confusion, mydriasis, and tachycardia of         tachycardia and dilated, sluggishly reactive pupils in
      approximately 3–4 hours duration. Approximately           five of the six patients. Temperatures ranged from
      4–5 hours earlier, all six family members had shared a    98.0ºF (36.7ºC) to 99.4ºF (37.4ºC). Respirations
      meal of homemade stew and bread. Subsequent inves-        ranged from 17 to 22 breaths per minute.
      tigation by the Montgomery County Department                  During the next 6 hours in the emergency
      of Health and Human Services (MCDHHS) and                 department, the six patients continued to experience
      the Maryland Department of Health and Mental              tachycardia, mydriasis, and altered mental status.
      Hygiene (MDHMH) determined that the stew                  One remained unconscious. The others demonstrated
      contained jimsonweed (Datura stramonium), a plant         confusion, aggression, agitation, disorganized speech,
      in the nightshade family that contains atropine           incoherence, and hallucinations. All six were admitted
      and scopolamine (1) and has been associated with          to the hospital, five to the intensive-care unit. The
      anticholinergic-type poisoning (1). This report           unaffected relative reported to providers that pesti-
      describes the poisoning incident, which resulted in six   cides had been sprayed on mint leaves that might have
      hospitalizations, and the subsequent multidisciplinary    been incorporated into the stew. However, a treating
      investigation. Health-care providers and public health    physician consulted the poison control center hotline
      officials should be aware that jimsonweed poisoning       and established that the illnesses were not consistent
      can occur among many age groups, including younger        with cholinergic poisoning, as would be expected with
      persons, who typically consume the plant material for     ingestion of organophosphate pesticides, but were
      recreational purposes, or persons of any age group        consistent with anticholinergic poisoning.
      who might unknowingly ingest the plant. A prompt              Complete blood counts, basic metabolic panels,
      diagnosis of jimsonweed poisoning is complicated          comprehensive metabolic panels, and urinalysis gener-
      by the difficulties in eliciting exposure histories in    ally were within normal limits. Urine screenings for
      persons with altered mental status and the variable       amphetamines, barbiturates, benzodiazipines, tetra-
      presentations of affected persons. Consultation with      hydrocannabinol, opiates, phencyclidine, and cocaine
      horticulturalists, poison control centers, and special-   were negative among four patients tested.
      ized laboratories might be necessary to investigate           Over the course of their hospitalizations, the
      cases and outbreaks.                                      patients’ signs and symptoms of anticholinergic toxic-
          The six affected persons came from one family and     ity fluctuated. In addition to tachycardia, mydriasis,
      included three men and three women ranging in age         and altered mental status, two patients experienced
      from 38 to 80 years (median age: 42 years). All six       urinary retention, and one had a small pleural effusion
      shared a meal of homemade stew and bread at approxi-      identified by computed tomography scan (Table).
      mately 9:00 p.m. on July 8, 2008. No one else was at      The patients received supportive care, including car-
      the home when the meal was eaten. Approximately 1         diac monitoring and intravenous fluids. Four of six
      hour later, another relative arrived at the home and      patients were administered lorazepam to control agita-
      discovered the six affected family members laughing,      tion. None were administered physostigmine. Their
      confused, and complaining of hallucinations, dizzi-       neurologic statuses improved during hospitalization

								
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