DELIRIANT POISONS: Dhatura,Strychnine

DELIRIANT  POISONS

Dhatura  {thorn  apple}

• Dhatura  (thorn  apple)  grows  on  waste  land  all over  india  and  is  of two  types

(i)  Dhatura alba  and  (ii) Dhatura  niger

 All parts  of plant  is  poisonous, especially  seeds and fruits.

Active  principles  of  dhatura:

1. levohyoscyamine,
2. Hyoscine (scopolamine) 
3. Atropine

Clinical features:poisoning is due to Anticholinergic;  These  features  are described  as ‘9D’

1. Dry  hot skin: Hot  as a hare.
2. Dilatation  of cutaneous  blood  vessels  causing  facial  Flush; Red as a beet.
3. Dialtion  of pupil with loss accommodation and unresponsive to light (dilated and fixed Pupil); Blind  as a hat.
4. Dryness of throat  and mouth: Dry as a bone.
5. Delirium (muttering  delirium): Mad as a wet hen.
6. Drowsiness
7. Drunken  gait
8. Dysphagia (difficulty  in  swallowings)
9. Difficulty  in talking.

• Earliest  symptom is  bitter taste  in the  mouth
• After delirium  passes  of patient  may  progress  to  stupor  or coma  and rarely  death  may occur  from  respiratory  paralysis.
• Cornpicker’s pupil :  It  is  unilateral  mydriasis  caused  by pollen.

Treatment:  physostigmine  is  the  drug  of choice.

• The  seeds of  dhatura closely  resemble  those  of the  capsicum

STRYCHNINE (NUX  VOMICA /  KUCHILA)

• spinal  poison.
• powerful  alkaloid  obtained  from  the  seeds  of strychnos nux  vomica.
• seeds  are poisonous which contain  active principles  strychnine, brucine and loganin.
• The main poisonous  alkaloid  is  strychnine.
• Strychine  is  used  as  a respiratory  stimulant, rodenticide, cattle  poison, and  for  killing  stray  dogs.
• Strychine stimulates  all parts  of CNS  and particularly  the  anterior  horn cells causing  greatly increased  reflex
• Cerebral  cortex (brain)  and respiratory  center are stimulated.
• It causes great incresed reflex activity by antagonizing the action of glycine.

Clinical features :

• Prodromal  symptoms,  e.g.  incresed  activity  of  perception,  rigidity  of muscles and twitching’
• Convulsions  afiecting  all  muscles at s time,  they  are  initially  clonic  and  eventually  become  tonic.
• Between  convulsions,  muscles  are completely relaxed
• Due  to  spasm  of  jaw  and  facial  muscles, corners  of mouth  are  drawn back   → Risus sardonicus.
•  Hyperextention  of  whole  body  → Opisthotonus.
• Spasm  of  abdominal  muscles  my  bend  the  body  forward  (emprosthotonus)  or to  the  side (pleurosthotonus)
• Mind  (consciousness)  remains  clear throughout  till  death
• Fatal dose  is  one  crushed  seed  ( 50–100 mg (1 mg/kg))  and  fatal  period  is  1-2  hours’
• Antidote 
• short acting  barbiturate,  e.g.  phenobarbital.
• Brain and spinal  cord  should  be  preserved  for  analysis (in addition  to  usual viscera)  in  deaths  from  suspected strychnine  poisoning.
• Strychnine  resist putrefaction.
• Rigor mortis  sets in  almost  immediately  and  passes off  early.

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