RESUMEN
The woody nightshade, Solanum dulcamara, belongs to the genus Solanum and its primary toxin is solanine. We report a large nightshade ingestion in a 4-yr-old girl who presented to the emergency department in acute anticholinergic crisis. The child was given 0.2 mg of intravenous physostigmine (0.02 mg/kg). Within 50 min, the patient received two additional equal doses with complete resolution of symptoms. After 36 h of observation, the child was discharged. Our patient presented with symptoms more suggestive of the deadly nightshade species, Atropa belladonna, which is native to Europe; however, a detailed laboratory analysis of the suspect berries revealed no atropine or hyoscyamine. Analysis did reveal sterols consistent with solanine. This is a unique case presentation of woody nightshade, S. dulcamara, poisoning presenting with anticholinergic crisis and responding to physostigmine.
Asunto(s)
Inhibidores de la Colinesterasa/uso terapéutico , Fisostigmina/uso terapéutico , Intoxicación por Plantas/tratamiento farmacológico , Alcaloides Solanáceos/envenenamiento , Preescolar , Antagonistas Colinérgicos/análisis , Antagonistas Colinérgicos/envenenamiento , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Plantas Tóxicas/química , Alcaloides Solanáceos/análisisAsunto(s)
Desarrollo Embrionario y Fetal/efectos de los fármacos , Contaminantes Ambientales/efectos adversos , Peces/metabolismo , Contaminantes Químicos del Agua/efectos adversos , Animales , Población Negra , Carga Corporal (Radioterapia) , Cromatografía de Gases , Estudios de Cohortes , Recolección de Datos , Diclorodifenil Dicloroetileno/efectos adversos , Diclorodifenil Dicloroetileno/sangre , Dieldrín/efectos adversos , Dieldrín/sangre , Contaminantes Ambientales/sangre , Femenino , Contaminación de Alimentos , Agua Dulce , Great Lakes Region , Humanos , Masculino , Bifenilos Policlorados/efectos adversos , Bifenilos Policlorados/sangre , Embarazo , Medición de Riesgo , Factores Socioeconómicos , Estados Unidos , United States Food and Drug Administration , Contaminantes Químicos del Agua/sangreRESUMEN
In a 1-year period, 15 of 4048 pregnant women were found to have thrombocytopenia during their first prenatal visit. Their qualitative and quantitative platelet abnormalities were followed up prospectively for 1 to 6 months post partum. Platelet counts returned to normal in 14 of 15 patients 4 to 6 weeks post partum. von Willebrand factor antigen and ristocetin cofactor activity were low in three of 15 patients 4 to 6 weeks post partum, but had been normal during the antepartum period. Two of these three patients had prolonged bleeding times ante partum and post partum. All three patients subsequently were found to have mild type I von Willebrand disease. Six patients had detectable platelet antibodies. Neonatal thrombocytopenia was found in one term infant of a patient with mild thrombocytopenia and negative platelet antibodies. This study suggests that mild, transient, isolated thrombocytopenia can occur in an otherwise normal pregnancy and its incidence may be lower than previously reported. Extensive testing is not indicated unless there is an associated prolonged bleeding time. The possibility of von Willebrand disease or a qualitative platelet disorder should be considered.