Chemical Poisoning with plant in Skaka, Saudi Arabia, November 2001

On Tuesday 20/11/2001 (5/9/1422 H), the Preventive Health Department reported poisoning in two children in Skaka, AlJouf; after eating a certain plant. A team from the Field Epidemiology Training Program was sent to investigate these cases. The team met with the Head of the Epidemiology Unit of the Department of Health Affairs of Al Jouf They visited the Maternity and Children's hospital in Skaka where the two girls had been admitted, visited the family home, and location where the plant grew. Medical history was obtained from the attending physician and the patients' father. Their hospital files were reviewed.

The first case: was a 5 year old Saudi female. She was brought to the hospital around 7:30 p.m. with abnormal gesticulations, facial redness, tachycardia, agitation, and dilated pupils. She had gone outside her home to play with her sister just before Maghrib prayers, and came in a few minutes later with a red face and complaining of headache. She convulsed and lost consciousness for about two minutes. She had some plant leaves in her hand. This plant is popular in the district, and is known to be unhealthy for both humans and animals. Her father took her to hospital after giving her some dates, after which she vomited. She received first aid on arrival to hospital. The child temporarily lost her vision at night, but she recovered completely on the second day.

The second case: was a four year old Saudi girl. She was brought to the hospital with her sister. She had also eaten from the same plant, and had similar symptoms, in addition to mouth dryness. She did not have fever, but had vomited three times. She did not have convulsions, fainting or loss of vision. She also recovered on the second day.

The two cases did not have any relevant medical history. They had both eaten from the same plant. The attending physician was familiar with the plant, which is known to contain an Atropine-like substance, and the two cases were treated as Atropine poisoning. There had been one similar reported case three years earlier, who was a three year old Saudi girl from Skaka, who had eaten this plant on a family outing.

The investigating team noticed that this plant grew in abundance in the district. A sample of the plant was sent to the Drugs and Poisons Laboratory in Riyadh, and to the Pharmacology Department of the College of Pharmacy, King Saud University, for identification. Its colloquial name was Egyptian Henbane, and its scientific name Hyoseyamus muticus L. (Solpmaceae). It is a perennial herbal green plant between 30-40 cm high, and has large green lobated oval leaves with sharp edges. Its flower is whit yellow with violet or purple and has a cylindrical shape. Its fruit has a flask shape 1,5 cm. tall and 6 mm wide, containing many brown €” black seeds. This plant has been reported from several geographical locations in the Kingdom, especially in the North-Eastern and Northern-Western regions. Its seeds arrive via rains from Jordan where it grows in large areas. All parts of the plant are toxic. Its toxic components are mainly Atropine (Hyoscyamine) and scopolamine (Hyoscine).

The main alkaloids in the Henbane plant; atropine and hyoscine, explains the clinical picture of mixed stimulation and depression of the brain. Serious intoxication may occur in children who ingest berries or seeds of these plants. The deliberate or accidental ingestion of belladonna alkaloids or other classes of drugs with atropinic properties is a major cause of poisonings, especially among infants and young children who are especially susceptible to their toxic effects. The belladonna alkaloids are absorbed rapidly from the gastrointestinal tract. They also enter the circulation when applied locally to mucosal surfaces of the body. Atropine has a half-life of about 2.5 hours, and most of the drug is excreted in the urine within the first 12 hours, in part unchanged.[1]

The most prominent signs of hyoscine poisoning in children are altered state of consciousness and flushed dry skin, severe thirst, dilated pupils, blurred vision, vomiting, increased tendon reflexes, convulsions, involuntary movements, ataxia, hypertension, hyperpyrexia and tachycardia, and occasionally death. In infants and small children moderate doses induce "atropine fever", where the temperature may reach 43° C or higher. [1]

Therapeutic intervention is not necessary except in cases where severe delirium or hyperthermia are present, when intravenous physostigmine and sedatives are given. [1] Cases of toxicity are treated with plenty of water and charcoal as first aid, and inducing the patient to vomit. The temperature is allowed to fall by wrapping the patient with a wet towel.

This plant is used medically in certain countries; in Nigeria, for example, it is used to treat colic and asthma. In Iran, smoke from its seeds is used to treat toothache. The main chemical component of this plant, Hyoscine, is found pharmaceutically under the name Buscopan.

Municipalities should be advised to cut out this plant from residential districts. Educational measures should be undertaken to prevent poisoning of children by eating such plants. Doctors should be educated on adequate treatment of cases, especially in areas where the plant grows.