A patient with confirmed severe Datura stramonium poisoning has agitation, hallucinations, mydriasis and urinary retention despite supportive care. The antidote used to reverse the central anticholinergic syndrome is:
- A Physostigmine ✓
- B Pralidoxime
- C Flumazenil
- D Cyproheptadine
Correct answer: A. Physostigmine
Explanation
Physostigmine, a tertiary amine cholinesterase inhibitor, crosses the blood-brain barrier and restores synaptic acetylcholine, reversing both central (delirium, coma) and peripheral anticholinergic features of tropane alkaloid poisoning; it is the classical textbook antidote for datura. Pralidoxime reactivates phosphorylated cholinesterase only in organophosphate poisoning, flumazenil reverses benzodiazepines, and cyproheptadine is used in serotonin syndrome. Neostigmine is sometimes used in Indian practice but does not cross into the CNS effectively.
Reference: Parikh's Textbook of Medical Jurisprudence and Toxicology, 8th ed.
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