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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.
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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