Deliriant Poisons:

The poison which produces delirium are called deliriant poison.
Eg. Datura, Cannabis indica, cocaine 

Delirium 
It is a disturbance of consciousness in which orientation is impaired, the critical faculty is blunted or lost and though content is irrelevant or inconsistent.

Stupefying Agents:

Agents that produce stupor are called stupefying agents.
Eg. Datura, Cannabis indica, Chloroform

Two varieties of this plant exist:

1. Datura alba, a white-flowered plant, and
2. Datura niger, a deep-purple flowered plant.

It grows in waste places all over India. The fruits are spherical and have sharp spines (thorn-apple), and contain up to 500 yellowish- brown seeds. The flowers are bell-shaped. All parts of these plants including nectar (honey) are poisonous, especially the seeds and the fruit.

They contain 0.2 to 1.4% of hyoscine (scopolamine), hyoscyamine, and traces of atropine.

Active Principles of Datura

• Hyoscine
• Hyoscyamine
• Trace of atropine

 

Fatal Dose: 0.6 - 1 gm (100 to 125 seeds) Fatal Period: 24 hours. For stupefying: 50-60 seeds or 1/2 dose or 1/3 dose (Ref Lecture) Crushed seed is fed for its action, because the normal uncrushed seed is not digested due to having a cellulose cover.

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ALKALOIDS:

An alkaloid is a complex substance having a nitrogenous base, and is found in various plants. Chemically, it behaves like an alkali in that it unites with acids to form salts.

Action:

The alkaloids atropine, hyoscyamine, and hyoscine first stimulate the higher centers of the brain, then the motor centers, and finally cause depression and paralysis, especially of the vital centers in the medulla.

The respiration is first stimulated, then depressed, and the heart center is stimulated. Peripheral effects are predominant and result from anticholinergic (parasympatholytic) action.

Form of datura: 

• If the crushed seeds are eaten, symptoms appear within half an hour,  
• If a decoction of the seeds is given - within a few minutes and  
• If alkaloids are used - almost immediately.

Signs and Symptoms of Datura Poisoning:

• Contact with leaves or flowers causes dermatitis in sensitive persons.
• A bitter taste, dryness of mouth and throat, with difficulty in talking, dysphagia, burning pain in the stomach, and vomiting are first noticed.
• The voice becomes hoarse.
• The face becomes flushed, conjunctivae congested, pupils widely dilated with loss of accommodation for near vision, developing in temporary blindness, photophobia and diplopia.
• Light reflex at first is sluggish and later absent.
• The pollen can cause unilateral mydriasis (cornpicker' s pupil).
• The skin is dry and hot, the pulse rapid 120 to 140 per minute, full and bounding, but later becomes weak and irregular, and the respirations are increased.
• The temperature may be raised by 2 or 3 degrees. Hyperpyrexia
• Mental changes include restlessness and agitation and the patient cannot recognize relatives or friends.
• The patient becomes confused, giddy, staggers as if drunk.
• Delirium
  
  

8 D's: Dryness of mouth, dysphagia, dilated pupils, dry; hot skin, drunken gait, delirium, drowsiness, death due to respiratory failure.

8 D's:

• Dryness of mouth,
• Dysphagia
• Dilated pupils, conjunctivae congested
• Dry; hot skin
• Drunken gait, Restlessness, Confused,
• Hallucinations of sight and hearing and delusions occur.
• Delirium
• Drowsiness
• Death due to respiratory failure. The patient passes into deep sleep or coma which may end rarely in death from respiratory paralysis.
• Ludicrous movement
• Burning pain in the stomach
• Rapid Pulse
• Increased Respiration

Ludicrous Movements

In the phase of the excitement of acute poisoning, ludicrous movement is observed, which is characterized by the Patient tries to run away from his bed, picks at the bed clothes, (carphologia), tries to pull imaginary threads from the tips of his fingers, threads imaginary needles.

Ludicrous - Foolish, unreasonable

Morton’s Classification/Signs of Datura Poisoning

Dry like Bone: Mouth & throat dry, intense thirst, hot & dry skin.

Hot like Hare: Rise of the temperature

Red like Beet: Flushing of the face followed by dilatation of cutaneous vessels.

Blind like Bat: pupils dilated,  loss of accommodation for near vision, temporary blindness, photophobia

Mad like Hen: Drunken gait, Delirium, Visual & auditory hallucinations

Treatment of Datura Poisoning:

(1) Emetics can be used.

(2) Wash-out the stomach repeatedly with a weak solution of tannic acid.

(3) Give activated charcoal and a cathartic.

(4) Wash-out the lower bowel frequently.

(5) Physostigmine 1mg. , I.V. or I.M., at hourly intervals.

(6) Pilocrapine nitratre, 5 mg. s.c. is useful, but it does not counteract the action of datura on the brain. It can be repeated after two hours.

(7) Morphine is to be avoided because of the danger of depressing the respiratory centre.

(8) Delirium can be controlled by bromides and short-acting barbiturates, but ether or chloroform is more beneficial.

(9) Light diet and free purgation should be carried on for 3 to 4 days to remove the seeds and to increase intestinal motility.

(10) Symptomatic

Pilocarpine is a medication used to reduce pressure inside the eye and treat dry mouth. (Ref Wikipedia)  Pie_lo carpine) Pronounce

 

Q. How to understand, if the patient is given treatment in Datura Poisoning?

• Pupil returns to normal. Datura cause pupil dilate. 
• Mouth becomes moist. Datura causes dry mouth. 

 

Postmortem Appearances of Datura Poisoning:

They are not characteristic but are those of asphyxia.
Seeds or their fragments may be found in the stomach and intestines.
The stomach may show slight inflammation and lung edema.
The seeds resist putrefaction for a long time.

Cause of death in Datura Poisoning (Ref Lecture) 

Death rate: Rare 
Cause of death - Respiratory failure 

Circumstances of Datura Poisoning: (Medicolegal Importance)

(1) Crushed or powdered seeds or an extract is used by criminals for stupefying a victim prior to the robbery, rape, or kidnapping (Road poison)/Travelers Poison.

It is usually given in food or drinks, e.g., chapatis, curry, sweets, tea, liquor, etc., to travelers in railway stations, choultries, etc. Sometimes, the seeds are mixed with incense wood, and the victim is exposed to the fumes which cause lethargy. The victim soon falls into a deep sleep and later wakes up to find his belongings lost.

(2) It is not taken by suicide.

(3) Homicide is very rare.

(4) It is sometimes used as an abortifacient.

(5) It is believed to have aphrodisiac properties.

(6) Accidental cases occur usually in children by eating fruits. The seeds and leaves are mixed with tobacco or ganja and smoked in a pipe.

(7) A decoction of seeds is sometimes added to liquor or toddy to increase the intoxicating property.

(8) It is sometimes used as a love philter.

A person suffering from the delirium of datura is not criminally responsible for his acts.

Mydriatic Test: (Simple Diagnostic Test)

A drop of the solution to be tested is put into the eyes of a cat. The pupils dilate within half hour if datura is present, due to the presence of atropine.