It’s the final part of “Name that Poisonous Beast!”. Today, we’re going to take a walk in the garden.
Name this poisonous beast!
A)
And it’s seedy neighbor:
B)
- A) Death cap mushroom (Amanita phalloides): amatoxin and phallotoxin
- Phallotoxin: n/v/d, abd pain 6-12h after ingestion, supportive care, improve within hours
- Amatoxin
- Heat-stable, water insoluble, not destroyed by drying
- Lethal dose: 0.1 mg/kg
- Interferes w/DNA and RNA transcription, affects areas with high protein synthesis
- Liver, kidneys, brain, pancreas, testes
- Clinical course: 3 stages
- Stage 1 (onset 6-12h): Abd cramping, vomiting, profuse watery diarrhea (hypotension/tachy)
- Stage 2 (onset 24-48h): clinical improvement, but ongoing liver/renal damage
- Inc AST/ALT/bili/LDH/ALP, inc PT/INR, inc Cr, jaundice
- Can induce pancreatitis, hypoglycemia
- Stage 3 (2-6 days): Severe coagulopathy, renal failure, encephalopathy (2/2 hepatic failure; confusion/agitation, seizures, coma), fulminant hepatic failure
- Treatment: MDAC, IVF, electrolyte repletion, HD in renal failure, liver transplant
- NAC: loading dose 150mg/kg IV; 4h infusion 12.5mg/kg/h, 16h infusion 6.25mg/kg/h
- Consider high dose penicillin G, vitamin C, cimetidine
- B) Jimsonweed (Datura stramonium): belladonna alkaloids (hyoscyamine, hyoscine, atropine, and scopolamine); anticholinergic
- Others with belladonna alkaloids: Datura (angel’s trumpet, thorn apple), Hyoscyamus niger (henbane), Atropa belladonna (deadly nightshade), Mandragora officinarum (mandrake)
- Symptoms occur 30-60 min post-ingestion and continue 24-48h 2/2 delayed GI emptying
- Hot as a hare: hyperthermia
- Blind as a bat: photophobia, blurred vision, mydriasis/cycloplegia
- Dry as a bone: dry MM/skin, dysphagia/dysarthria, anhidrosis
- Red as a beet: flushed skin
- Mad as a hatter: delirium, confusion, agitation, hallucinations, seizures, coma
- Full as a flask: urinary retention, delayed gastric emptying
- Additional: tachycardia/tachydysrhythmias, tachypnea
- Treatment: activated charcoal, supportive care/benzos
- Physostigmine with peripheral AND moderate central toxicity; have atropine nearby
- Dose: 0.5-2mg slow IVP, if no response repeat q20min
- If initial dose effective, may give additional 1-4mg q30-60min PRN
- Contraindicated in TCA, cocaine, quinidine, procainamide users
- Dose: 0.5-2mg slow IVP, if no response repeat q20min
- Physostigmine with peripheral AND moderate central toxicity; have atropine nearby