Using Forensic Nursing Skills to Diagnose Jimson Weed Poisoning

Jimson weed is a highly poisonous weed. It is characterized by large white or violet trumpet-shaped flowers. The weed has globular prickly fruits. The main ingredients from the weed are belladonna alkaloids, atropine and scopolamine. One can ingest jimson weed by smoking leaves or drinking tea that contain jimson.

Multiple symptoms are exhibited. The common saying “red as a beet, hot as a hare, dry as a bone, blind as a bat, mad as a hatter, the bowel and bladder lose their tone, and the heart runs alone” describes Jimson’s effects.

The atropine and scopolamine block the neurotransmitter acetylcholine which results in mydriasis, cycloplegia, dry mouth, high temperature, ileus, urinary retention, and tachycardia. Psychological effects can be seen as well: confusion, euphoria, delirium, and hallucinations. In extreme cases, users can experience seizures, intense visual or auditory hallucinations, or cardiac arrest.

The onset of symptoms is within 30-60 minutes after smoking leaves or drinking tea. The onset after ingestion of plant material or seed is 1-4 hours. The duration of symptoms is often 24-48 hours because of delayed gastrointestinal motility. Symptoms have been reported to last up to 1-2 weeks.

Diagnosis may be determined by detection of atropine and hycosyamine in urine. Elevated aspartate aminotransferase, LDH, bilirubin and prothrombin time levels may be detected secondary to muscle breakdown from seizures, increased tone and hyperthermia. An EEG may show changes from an increased slow wave activity to a bizarre high voltage pattern.

Treatment for jimson weed poisoning is based on the clinical evaluation. As with all poisonings, priority is given to the ABC’s of resuscitation. Providing a nonstimulating environment and assessing frequent vital signs are a must. If stupor or coma exists, the patient may be treated with dextrose, thiamine, or naloxone. A cooling blanket is used for hyperthermia. Administration of activated charcoal should be considered to decrease the amount of absorption.

As a forensic nurse, it is important to realize that these poisonings are possible. Jimson weed is not a common poisoning, but should be considered as a possible diagnosis. The symptoms of jimson weed have a tendency to mimic other disorders and may be overlooked if not part of the differential diagnosis.

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