Effect Measure

On admission to the emergency department, two of the six patients were unconscious. The other four were awake and had altered mental status; complete history of meal preparation and food exposures could not be obtained. Physical examinations revealed tachycardia and dilated, sluggishly reactive pupils in five of the six patients. Temperatures ranged from 98.0ºF (36.7ºC) to 99.4ºF (37.4ºC). Respirations ranged from 17 to 22 breaths per minute.

During the next 6 hours in the emergency department, the six patients continued to experience tachycardia, mydriasis, and altered mental status. One remained unconscious. The others demonstrated confusion, aggression, agitation, disorganized speech, incoherence, and hallucinations. All six were admitted to the hospital, five to the intensive-care unit. The unaffected relative reported to providers that pesticides had been sprayed on mint leaves that might have been incorporated into the stew. However, a treating physician consulted the poison control center hotline and established that the illnesses were not consistent with cholinergic poisoning, as would be expected with ingestion of organophosphate pesticides, but were consistent with anticholinergic poisoning. (CDC, Morbidity and Mortality Weekly Reports)

Organophosphate pesticides enhance the actions of a neurotransmitter, acetyl choline, causing continued nerve stimulation. But the symptoms of these patients were just the opposite one would expect from a cholinergic effect. They were an anti-cholinergic effect, more typical of drugs like atropine (often used to counter the effects of pesticide-like nerve agents) or scopolamine. How did these things find their way into the stew? Foul play?

After she regained her faculties, epidemiologists were able to question the cook who said the stew was mainly potatoes, but also had garlic, onion, tomato, curry powder, and leaves from two plants growing in the yard. One of the plants was definitely mint, but the other one was only identified as something that grew wild in the yard. It turned out the "other plant" was jimsonweed (aka thorn apple, angel's trumpet, and Jamestown weed), sometimes used infused as a tea by callow youth in the never ending search for a good high. Cut jimsonweed was found in the yard and in leftover stew, which also contained atropine, scopolamine and a couple of other anti-cholinergic glycoalkaloids.

It's likely that this episode was due to the jimsonweed but the CDC and Maryland investigators did consider one other possibility: the potatoes. Potatoes? It turns out that potatoes are members of the deadly nightshade family and also contain anticholinergics, but only in significant amounts when they are green or sprouting. No samples of the potatoes were available, however, and it is likely the toxic agent was the jimsonweed.

I'm all for eating healthy foods, and the stew recipe sounded tasty. But you can't just throw stuff in there, even if it looks like Nature's Bounty, and not run some risks. Still, jimsonweed poisoning is hard to diagnose and pretty uncommon. So if you drop in on friends and relatives tonight after their Superbowl Party and find them laughing, confused, hallucinating and vomiting, it probably isn't from jimsonweed. At least not the jimson part.