Conservative treatment of jimsonweed ingestion

The use of physostigmine for the treatment of jimsonweed ingestion remains controversial. We have reviewed the records of 29 cases reported to the Kentucky Regional Poison Center (KRPC) over a 7-y period during which time physostigmine was not recommended by the Center to assess the results of conservative therapy. 28/29 cases represented intentional abuse; 26/29 were males and the mean age for the group was 18.9 y (range 16 mo to 39 y). The reported ingested amounts ranged from a few to 1/2-cup of seeds. Typical mild anticholinergic symptoms including mydriasis, tachycardia, flushing, hallucinations, and both agitated behavior and lethargy were observed. No patient had life-threatening symptoms. All cases were referred to the Emergency Department, although only 20 complied. Of these, 17 were admitted for stays of 1-3 d (mean 1.8). Seventeen patients received activated charcoal on recommendation of the KRPC. Three patients with hallucinations received 1 or more doses of valium or haloperidol for sedation. All patients recovered uneventfully. We conclude that conservative treatment of jimsonweed ingestion is safe and adequate.