Deadly Nightshade (Atropa belladonna) and Other Weed Poisonings in the Pediatric Intensive Care Unit: Analysis of 54 Children

Abstract

Objective: Atropa belladonna, known as the deadly nightshade, is one of the most poisonous plants in the world. Deadly nightshade poisoning in both children and adults has been rarely reported and is mostly in the form of case reports. The aim of this study was to illuminate the findings of weed poisoning in childhood. Materials and Methods: Clinical and laboratory findings of 54 children with acute deadly nightshade and other weed poisoning followed in our center between January 2010 and January 2022, were retrospectively reviewed. Results: In the study analyzing 54 children admitted to the pediatric intensive care unit for poisoning, 24 cases (44.4%) were attributed to deadly nightshade, with the remaining cases involving other weed poisonings. The most common symptoms were flushing, vomiting, mydriasis, gibberish, dry mouth, and tachycardia. Three patients required mechanical ventilation. No patient was dead. Patients were categorized into 2 groups: mild/moderate (no encephalopathy, n : 46) and severe poisoning (with encephalopathy, n : 8). The severe poisoning group had a higher incidence of urinary retention, incoherent speech, dry mouth, agitation, lethargy, convulsions, and coma, which led to longer intensive care unit (ICU) stays and an increased need for respiratory support (P < .05). Furthermore, a statistically significant difference was observed between deadly nightshade poisoning and other weed poisonings, particularly in the presence of symptoms such as headache, flushing, mydriasis, incoherent speech, encephalopathy, convulsions, and coma, all of which contributed to extended ICU stays and elevated respiratory support requirements (P < .05). Notably, neostigmine was administered in all cases of deadly nightshade poisoning due to the unavailability of physostigmine. Our findings showed that the first signs and symptoms of acute deadly nightshade and other weed poisoning may be severe in some children, but no death was observed. Meaningless speech, mydriasis, coma, and lachrymation were negative prognostic signs in childhood weed poisoning. We believe that neostigmine may be an alternative for deadly nightshade poisoning in cases when physostigmine is unavailable. Conclusions: Our study highlights the severity of poisonings involving deadly nightshade and other weeds in pediatric patients. Despite the significant clinical manifestations observed, no fatalities were recorded. The findings underscore the importance of early recognition and appropriate management, emphasizing the need for heightened awareness among healthcare professionals and caregivers.