Datura stramonium (jimson weed) poisoning produces the classic toxidrome of dry mouth, tachycardia, dilated pupils, urinary retention, hyperthermia, and agitated delirium. The specific antidote and the correct dose consideration in Datura poisoning is:
- A Atropine 2–4 mg IV; repeated until secretions are controlled
- B Pralidoxime (2-PAM) 30 mg/kg IV; reactivates inhibited acetylcholinesterase
- C Physostigmine 1–2 mg IV slowly; it crosses the blood-brain barrier and reverses both peripheral and central anticholinergic features ✓
- D Naloxone 0.4–2 mg IV; competitive opioid receptor antagonist reverses sedation
Explanation
Datura contains tropane alkaloids (atropine, scopolamine, hyoscyamine) that block muscarinic receptors producing an anticholinergic toxidrome. Physostigmine is a reversible cholinesterase inhibitor that crosses the blood-brain barrier, increasing acetylcholine availability at both peripheral and central muscarinic receptors, effectively reversing all features including agitated delirium. Atropine would worsen anticholinergic toxicity. Pralidoxime is for organophosphate cholinesterase reactivation. Naloxone reverses opioid, not anticholinergic, toxicity.
Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.
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Written and medically reviewed by the StethoPrep medical team.