DATURA POISONING

Signs & Symptoms, Treatment, and Medicolegal Importance

I. INTRODUCTION

Fig.: Datura alba plant (left), Datura seeds - brown/dried (centre), fresh seeds (right) - The Essentials of Forensic Medicine and Toxicology, 36th Ed.

II. BOTANICAL DESCRIPTION AND VARIETIES

III. ACTIVE PRINCIPLES (MECHANISM OF TOXICITY)

1. Hyoscine (scopolamine) - the most important
2. Hyoscyamine - most abundant by weight
3. Traces of Atropine (believed to be the racemic form of hyoscyamine formed during extraction)

IV. SIGNS AND SYMPTOMS

A. Classic Mnemonic - "5 Phrases"

B. The "10 D's" of Datura Poisoning

1. Dysphagia - difficulty in swallowing and talking
2. Delusions - false beliefs
3. Dermatitis - skin rash on contact; at times scarlatiniform rashes or exfoliation of skin over the body
4. Delirium - altered state of consciousness, failure to identify oneself
5. Drowsiness - progressing to coma
6. Dry skin and mucous membranes - intense thirst, bitter taste, dryness of mouth and throat
7. Dilated pupils (Mydriasis) - with photophobia; loss of accommodation for near vision; red and injected conjunctiva
8. Dreadful hallucinations - of sight and hearing
9. Dysuria - inability to pass urine (urinary retention)
10. Dysarthria - difficulty in speaking

C. Detailed Systemic Features

• Bitter taste and burning pain in stomach
• Vomiting may occur immediately after ingestion (gastric irritation)
• Dysphagia

• Pulse is initially full and bounding
• Later becomes weak, irregular and intermittent

• Respiration is increased initially
• Death from respiratory paralysis in severe cases

• Headache followed by giddiness
• Staggering gait and incoordination of muscles
• Muscle tone and deep reflexes are increased
• Muscular spasms may be present
• Pin-rolling movements of fingers
• Dreadful hallucinations of sight and hearing
• Delusions; patient may become dangerous - can climb objects, break things, run out of bed, try to pick up non-existent objects

• Dry and hot skin with hyperthermia (107-108°F)
• Flushing of face
• Scarlatiniform rashes may appear

• Dilated pupils (mydriasis)
• Photophobia
• Loss of accommodation for near vision
• Red and injected conjunctiva

D. Course of Illness

• Excitement phase lasts 1-2 hours
• Then passes into deep coma or sleep which may end in death from respiratory paralysis
• Illness may last 2-3 days with definite improvement at 24 hours
• Recovering patients develop secondary delirium as stupor passes
• Amnesia - patient remembers nothing about the illness and is surprised to find themselves in hospital

V. FATAL DOSE AND FATAL PERIOD

VI. TREATMENT

A. Gastrointestinal Decontamination

1. Emetics - can be given
2. Stomach wash - using 5% tannic acid or weak potassium permanganate solution. Due to decreased gut motility caused by the poison, stomach wash is useful even several hours after ingestion
3. Enema - using sodium sulphate as purgative

B. Antidotes

1. Physostigmine 0.5-1 mg IV or IM, 1-2 hourly - physiological antidote of choice
   • Crosses the blood-brain barrier
   • Relieves both cerebral and peripheral manifestations
   • 1-2 mg IV slowly, every 5 minutes until poison signs disappear
2. Prostigmine (Neostigmine) 0.5-1 mg subcutaneously as single dose - more effective and less toxic (does NOT cross blood-brain barrier)
3. Pilocarpine nitrate 5 mg subcutaneously as single dose, repeated after 2 hours - has no central action

C. Symptomatic Management

1. Maintain airway and respiration - artificial respiration and oxygen inhalation
2. Short-acting barbiturates - for convulsions
3. Sponging - to relieve hyperthermia
4. Nursing care - to prevent falls, jumping from bed, or running away
5. Sedation is usually not indicated
6. Morphine - contraindicated (though physiological antidote, it is too toxic)

VII. AUTOPSY / POSTMORTEM FINDINGS

1. Postmortem findings are not characteristic
2. Signs of asphyxia are present
3. Seeds or their fragments may be found in the stomach or intestine
4. Stomach shows slight inflammation
5. Lungs are congested and oedematous
6. All the organs are congested

VIII. DIFFERENTIAL DIAGNOSIS OF DATURA POISONING

IX. MEDICOLEGAL IMPORTANCE

A. Criminal (Homicidal/Felonious) Use

1. Stupefying agent - Datura is most commonly used to stupefy travellers for the purpose of robbery, rape, and theft by:
   • Seeds mixed with rice, dal, coffee, sweets, pan or bidi (beedi)
   • Seeds and leaves mixed with tobacco or ganja and smoked in chillum (pipe)
   • Decoction of seeds added to liquor to enhance its intoxicating property
   • Crushed seeds mixed with sweets and given to school children to kidnap or rape victims
2. Homicidal use - though rare, documented cases exist. Historical case: In 1921, a wife administered Datura seeds to her husband in food.
3. Abortifacient use - Datura has been used to produce criminal abortion. Documented case where a man administered Datura powder to a woman to produce abortion and she died 3 hours later.
4. Post-poisoning amnesia - The victim remembers nothing about the events after poisoning, making it highly suitable for criminal purposes.

B. Accidental Poisoning

1. When children and adults eat raw Datura fruits (mistaking them for edible fruits)
2. Seeds may be mistaken for capsicum (chilli) seeds - an important identification point. Datura seeds are bitter and larger; chilli seeds are smaller and pinkish
3. Seeds have an erroneously believed aphrodisiac property
4. Juice of Datura leaves is used in folk medicine to treat rheumatism
5. Vaids and Hakims use Datura in traditional medicine
6. Accidental mixing with fodder or food grains (seeds resist putrefaction)
7. Himalayan Sadhus are known to consume seeds intentionally for psychoactive effects

C. Suicidal Use

• Less common than homicidal/accidental cases

D. Forensic Chemistry and Preservation

• Active principles are excreted unchanged in urine within 10-12 hours after administration - urine must be preserved for chemical analysis
• Datura seeds resist putrefaction for a long time
• However, the mydriatic principle (alkaloids) is destroyed by putrefaction
• Can be chemically detected even after a long time (seeds remain identifiable)

E. Medicinal (Therapeutic) Uses

1. Dried leaves mixed with cannabis in cigarettes used for asthma treatment (antispasmodic smoke)
2. Belladonna tinctures used for application on wounds
3. Datura leaves used to treat some types of fever

X. CLASSIFICATION SUMMARY

SOURCES

• P.C. Dikshit - Textbook of Forensic Medicine and Toxicology, pp. 508-510 (ISBN: 9788188867967)
• The Essentials of Forensic Medicine and Toxicology, 36th Edition, 2026, pp. 583-584 (ISBN: 9789366165257)
• Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology (ISBN: 9789388902267)