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Treatment of datura poisoning, refer reddy

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I now have all the information needed from Reddy's textbook. Here is the complete answer:

Datura Poisoning - Treatment (as per Reddy's Forensic Medicine & Toxicology, 36th ed.)

The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026), p. 584

Background

Datura (Datura stramonium, family Solanaceae) is a delirient/anticholinergic poison. All parts of the plant are poisonous, with seeds having the maximum concentration of active principles.
Active Principles (all anticholinergic):
  1. Hyoscine (scopolamine)
  2. Hyoscyamine
  3. Opium (to some extent)
Datura alba - plant and seeds (Fig. 35.9)

Signs of Poisoning

Reddy lists the classic mnemonic phrases:
  1. Hot as a hare - hyperthermia
  2. Blind as a bat - mydriasis (dilated pupils)
  3. Red as a beet - flushed skin
  4. Dry as a bone - dry mouth, dry skin
  5. Wet as a mad hen - urinary retention/dysuria

The "D's" of Datura (Common Symptoms):

  1. Dryness of mouth with nausea and vomiting
  2. Dysphagia - due to irritation of gut
  3. Dilated pupils - reddish flushed face
  4. Diplopia - conjunctiva red
  5. Dry hot skin
  6. Drunken gait
  7. Delirium - altered state of mind, confusion, fails to identify oneself
  8. Drowsiness
  9. Dysuria - painful urination
  10. Death - if untreated

Fatal Dose & Period

ParameterValue
Fatal dose50-100 crushed seeds (if ingested)
Fatal period1-2 days if untreated

Treatment

1. Gastric Lavage (Stomach Wash)

  • Indicated if brought within 1-2 hours of ingestion
  • Use plain water or potassium permanganate solution
  • Important note: Datura causes decreased gut motility, so stomach wash can remove unabsorbed poison even a few hours later

2. Airway and Respiration

  • Maintain patent airway and adequate respiration (supportive care)

3. Nursing Care

  • Prevent fall, jumping from bed, or running away
  • Patient is restless, delirious, and dangerous to themselves and others

4. Sedation

  • Usually not indicated

5. Antidote - Physostigmine ⭐

  • Physostigmine is the physiological antidote
  • Dose: 1-2 mg IV slowly, repeated every 5 minutes if necessary, until the signs and symptoms disappear
  • Mechanism: Physostigmine is a reversible acetylcholinesterase inhibitor - it produces effects exactly opposite to Datura (i.e., cholinergic effects counteract the anticholinergic toxidrome)

Autopsy Findings (if fatal)

  1. Presence of signs of asphyxia
  2. Presence of crushed seeds in stomach and small intestines

Medicolegal Significance

  • Widely used as a stupefying agent for robbery, rape, and kidnapping
  • Crushed seeds are mixed with sweets or pan-beedi and given deceitfully
  • Seeds resist putrefaction - important for forensic analysis
Source: The Essentials of Forensic Medicine and Toxicology, K.S. Narayan Reddy, 36th Edition (2026), Chapter 35 - Delerients, p. 584
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