2. English reference strain poisoning [Chinese medicine terminology examination and approval committee. Terminology of traditional Chinese medicine (20 10)]
3 Overview Datura stramonium poisoning (1) is the name of the disease [2]. Refers to toxic diseases caused by excessive consumption of flowers, leaves, stems, roots and seeds of Datura stramonium [1].
Datura stramonium is a common plant in gardens. Datura, also known as Datura flower, maple eggplant flower [2]. Also known as speranskia tuberculata, morning glory, eggplant, Buddleja, wild flowers, eggplant or wild hemp seed, the roots, stems and leaves are all toxic, among which the seeds are the most toxic. If you eat seeds or stems and leaves by mistake, it may cause poisoning.
4 Datura poisoning Datura mainly contains organic base Datura stramonium and a small amount of atropine and scopolamine, and most Datura stramonium can eventually evolve into atropine [3]. Therefore, Datura stramonium poisoning is mainly manifested as atropine-like poisoning, which can excite the brain and medulla oblongata in the central nervous system and antagonize or paralyze the parasympathetic nerves in the peripheral nervous system [3].
4. 1 Clinical manifestations The symptoms of Datura stramonium poisoning vary with the types and quantities of various alkaloids, and the onset speed also varies with food intake and personal physique [3]. Symptoms usually appear within 0.5 ~ 3h hours after ingestion. At first, the symptoms are dry mouth, flush on skin and face, erythema, dryness and anhidrosis, little saliva, anxiety, panic or lethargy, then delirium, hallucinations, auditory hallucinations, dancing with hands and feet, and even spasms, or rigidity or clonus in severe cases [3]. Often accompanied by fever, a few people's body temperature can reach more than 40℃, pupils are dilated, light reflex disappears or weakens, blood pressure rises, tachycardia,12 ~ 24 hours later, mania and delirium enter coma, which can lead to death [3]. If the rescue is timely or the poisoning is mild, the above symptoms will gradually disappear, and the pupil will generally return to normal after 1 ~ 3 days, or even extend 1 ~ 2 weeks [3]. After cure, patients often completely forget the course of disease [3].
Datura stramonium poisoning is sometimes not completely similar to atropine poisoning, but there is no fever, redness and erythema, which may be caused by the antagonistic effect of scopolamine [3].
4.2 Laboratory examination 1. Datura stramonium seeds, leaves or flowers were found in the stomach contents [3].
2. Identification experiment: Cat's eye mydriasis test: Because the cat's pupil is particularly sensitive to atropine, a drop of water containing atropine 0.0002mg can dilate the cat's pupil. Because atropine is excreted with urine, the patient's urine is dripped into the cat's eye to determine whether the patient has taken atropine or other similar drugs [3].
4.3 Diagnostic Points According to the patient's history of eating Datura stramonium seeds, fruits, flowers or leaves by mistake, combined with clinical manifestations and laboratory examination, a diagnosis can be made [3].
4.4 treatment point 1. Induced vomiting, gastric lavage and catharsis [4].
2. Intravenous infusion and diuresis to accelerate the excretion of poisons [4].
3. You can choose the following drugs to detoxify [4].
(1) pilocarpine 3 ~ 10 mg, injected subcutaneously every 4 ~ 6 hours, until the pupil is narrowed and the mouth is moist, and the dosage is reduced and stopped [4]. In severe poisoning, 3 ~ 5 mg each time, once every 15 ~ 30 min, and gradually reduce and extend the interval after the symptoms are relieved [4].
(2) physostigmine 1 ~ 2 mg, subcutaneous injection, 15 ~ 60 min once, and gradually reduce the dosage after the symptoms are relieved [4].
(3) Neostigmine (0.5 ~ 1 mg) is injected subcutaneously or intramuscularly every 3 ~ 4 hours, and gradually reduced after the symptoms are relieved, or taken orally, with a dose of 10 ~ 15 mg each time, 2 ~ 3 times /d [4].
4. For critically ill patients, adrenocortical hormone should be used sufficiently in early stage [4].
5. Symptomatic treatment: pay attention to sedation and antispasmodic treatment to prevent and treat brain edema. Patients with high fever should be given physical cooling. Patients with dilated pupils can use 1 ~ 2% procaine eye drops, and cardiotonic if necessary [4].
6. Traditional Chinese medicine treatment: Flos Lonicerae, Fructus Forsythiae, Glycyrrhrizae Radix and mung bean peel all have certain detoxification effects on Datura stramonium poisoning [4].
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