Physostigmine in Hyoscyamus Niger Intoxication:Is it an Antidote Myth?

Introduction: Hyoscyamus niger intoxication (HNI) is usually seen in children and its diagnosis is based on history and clinical symptoms. Approach to intoxication: physostigmine therapy is an alternative to general approach in the treatment of intoxicated patients. However, physostigmine is a generally accepted antidote; it is not always accessible in every region or place. This retrospective study aimed to evaluate HNI cases in which physostigmine were not administered. The study examined the clinical outcomes, the follow-ups after discharge, and the laboratory analyses in order to see the impact of presence and absence of physostigmine administration in the treatment of HNI.

Method: 27 patients who presented to the hospital because of HNI intake were included in the study. Laboratory values, hospitalizations and outcomes of the patients were recorded. Patients’ clinical status and admissions to E.R. in the following three-month period after the discharge were examined by having contact with the patients.

Results: Although blood values of all the patients were in the normal reference ranges, direct bilirubin and ALT values were higher in the patients hospitalized to intensive care unit. Stomach lavage was applied to all patients and supportive care was started. Any complications including death, intubation and mechanic ventilation were not developed in the patients. All the hospitalized patients were discharged in four days. After the discharge, all the patients were contacted and questioned about whether they had any admissions to E.R., and had any complications or not. It was seen that none of them had a hospital admission associated with HNI.

Concerning the findings in our study and the literature in which patients were not administered physostigmine, we can state that instead of administering physostigmine in HNI patients, applying supportive toxicology approach is more accurate.