Clinical Winner
Jimson Weed: A Case of Mistaken Identity
By Ann Campagna, M.D., University of Minnesota
A 49-year-old Hmong male with a history of renal insufficiency presented to the emergency department unresponsive after ingestion of an herbal remedy. The patient had complained of abdominal pain early that morning, and his wife had cooked him eggs with a traditional herbal substance used to treat stomach aches. The mixture was steamed and then ingested by the patient. Immediately after eating the plant, the patient felt ill. He soon became unresponsive and was brought by ambulance to the hospital. On arrival, he was intubated and admitted to the medical intensive care unit.
Family members brought in the leaves that were used in the concoction, but could not name the plant from which they came. Toxicologists compared them with pictures in a reference book, but there was still confusion. The leaves were then sent to botanists, who identified them as Datura stramonium, more commonly known as Jimson weed.
The patient recovered without consequence and was discharged home 2 days later.
Jimson weed often grows as a wild herb in the United States. It is probably best known among the adolescent population for its hallucinogenic properties. In addition to being hallucinogenic, the leaves also can have varying levels of toxicity.
When ingested, Jimson weed produces a toxidrome of anticholinergic intoxication. Anticholinergic effects are commonly thought of as “hot as a hare, red as a beet, dry as a bone, blind as a bat, and mad as a hatter.” Ingestion could be mistaken for tricyclic overdose or any other cause of delirium and altered mental status.
Physicians need to be aware of the effects of Jimson weed when ingested and know how to treat the anticholinergic symptoms.