6527 - Jimsonweed (Datura stramonium)

Be careful what you burn and where the smoke is going. I had a friend that did this with poison ivy.

NeuroClub

Abdel Rahman Bani Yassin

Case Discussion: Accidental Jimsonweed Exposure Leading to Anticholinergic Toxidrome

Case Presentation

A 48-year-old previously healthy male was brought to the emergency department by paramedics after being found confused and agitated in his backyard. According to his spouse, he had been cleaning overgrown vegetation in the yard on a hot afternoon, using a controlled burn pile. Several hours later, he began behaving strangely—complaining of extreme dry mouth, blurry vision, and became increasingly confused and restless.

On arrival, he was agitated, incoherent, and repeatedly picking at invisible objects in the air. His skin was flushed, dry, and hot to the touch. Vital signs were notable for tachycardia (HR 132 bpm), hypertension (BP 158/92 mmHg), tachypnea (24 breaths/min), and hyperthermia (T 39.1°C/102.4°F). Pupils were widely dilated and poorly reactive to light. Bowel sounds were absent.

Diagnostic Assessment

Initial laboratory studies, including electrolytes, renal function, and complete blood count, were within normal limits. Serum toxicology screen was negative for common drugs of abuse. Electrocardiogram showed sinus tachycardia with a widened QRS complex (112 ms).

Given the clinical presentation and recent outdoor activity involving burning vegetation, a diagnosis of anticholinergic toxidrome secondary to inadvertent Jimsonweed (Datura stramonium) exposure was strongly suspected. The patient’s wife later confirmed the presence of thorn-apple (Jimsonweed) plants in the area he was clearing.

Pathophysiology

Jimsonweed contains potent anticholinergic alkaloids, including atropine, scopolamine, and hyoscyamine. These compounds competitively inhibit muscarinic acetylcholine receptors, leading to widespread parasympathetic nervous system suppression. Inhalation of smoke from burning plant material can rapidly deliver high doses of these alkaloids, resulting in systemic toxicity.