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Clinical uses and toxicity of Atropa belladonna; an evidence based

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Medical
Communication
Biosci. Biotech. Res. Comm. 11(1): 41-48 (2018)

Clinical uses and toxicity of Atropa belladonna; an

evidence based comprehensive retrospective review
(2003-2017)
Hanine Almubayedh1, Reem Albannay1, Kawthar Alelq1, Rizwan Ahmad2*, Niyaz Ahmad3
and Atta Abbas Naqvi4
1
College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
2
Natural Products and Alternative Medicines, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal
University, Dammam, Saudi Arabia
3
Department of Pharmaceutics, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University,
Saudi Arabia
4
Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University,
Saudi Arabia

ABSTRACT
Atropa belladonna (AB), commonly known as deadly nightshade is a poisonous plant which contains several alkaloids such as
atropine and scopolamine etc. Any deliberate as well as unintentional ingestion of AB fruits, roots or leaves may result toxicity.
Aim of the study: This study aims to present the clinical uses of atropine alongwith the adverse effects and toxicity associated
with the use of atropine in the form of conventional or as herbal medication. A retrospective (2003-2017) literature was searched
in various databases such as web of science, PubMed, google scholar, Scopus, E-Resource Portal of Imam Abdulrahman bin Faisal
University etc. using the keywords i.e. AB, clinical uses of AB, adverse effects and cases reported with AB. Ten (10) cases met the
eligibility criteria where the toxicity was mostly associated with the use of AB fruit, tablets and AB contaminated drinks. Major
symptoms observed in these cases were related to Anticholinergic syndrome (ACS); tachycardia, dilated pupils, confusion, flushed
dry skin, hallucinations and seizures in some cases alongwith a toxic megacolon. Furthermore, the treatment protocol used widely
for ACS consisted of; gastric lavage and the use of Physostigmine as an antidote (antagonizes the central as well as peripheral
toxicity of atropine). AB fruit revealed a vital role as anticholinergic drug, mydriatic agent and as an antidote for OP poisoning,
however, its use deprived of medical supervision or in a large quantity, it may cause severe toxicity.

KEY WORDS: ATROPA BELLADONNA, CLINICAL USES, TOXICITY, ANTICHOLINERGIC, CASES REPORTED

ARTICLE INFORMATION:
*Corresponding Author: [email protected]
Received 12th Feb, 2018
Accepted after revision 25th March, 2018
BBRC Print ISSN: 0974-6455
Online ISSN: 2321-4007 CODEN: USA BBRCBA
Thomson Reuters ISI ESC / Clarivate Analytics USA and
Crossref Indexed Journal
NAAS Journal Score 2017: 4.38 SJIF 2017: 4.196
© A Society of Science and Nature Publication, Bhopal India

41
2018. All rights reserved.
Online Contents Available at: http//www.bbrc.in/
DOI: 10.21786/bbrc/11.1/6
Hanine Almubayedh et al.

INTRODUCTION of AB in a child and ten bays in an adult. The most com-

mon cause of AB intoxication in children is confusion
Solanaceae, an alkaloidal containing plants family, is with some other berries such as blueberries and black-
well known for its applications in cosmetics, traditional currant.(Berdai et al., 2012).
medicines and as a poison since ancient times. Atropa Atropa belladonna toxicity can be classified as
belladonna, synonym; deadly nightshade, belongs to mild, moderate and severe intoxication. Various treat-
the family solanaceae and is known for its effects on ment plan, depending the severity and condition of the
“increase pupil size” which imparted it the name of patients, are used for treatment of Atropa belladonna
“beautiful lady” (Atropa; Greek word means “goddess” intoxication including gastric lavage and Neostigmine
& Belladonna; Italian words means “beautiful lady”). It and Physostigmine, as an antidote. (Caksen et al., 2003;
is a tall plant that can reach up to five feet and it’s Ahmad et al., 2017c)
abundantly found in waste ground and quarries. AB Numerous literature is available regarding the clini-
has oval shaped leaves, greenish to purple color flowers cal uses, adverse effects and toxicity cases of AB; how-
and black, globular shape, sweet berries. Though leaves ever none of the studies have reported a complete and
and roots are poisonous and ingestion of a single leaf updated review about the comparative effects of AB in
can cause severe ACS which may be fatal, however the treating various conditions and the adverse effects of
berries have been reported with more poisonous cases toxicity thus reported. Current study highlight evidence-
in children due to its attractive look and sweet taste. based clinical uses alongwith toxicity observed with AB
The major components in the leaves, fruits and roots use and the most common reason of toxicity i.e. due to
are mostly alkaloids such as Hyoscyamine, scopolamine intentional or unintentional use of atropine tablets, bar-
and more abundantly; atropine, which is responsible for riers, leaves or plant as a whole.
the plant’s Anti-cholinergic toxic effects, (Berdai et al.,
2017; Ahmad et al., 2017a).
Atropa belladonna plant is surrounded by fear, awe, MATERIAL AND METHODS
and myth. The Romans and Greeks believed the fact of
AB containing a deadly poison due to more wide use DATABASES SEARCHED
by professional poisoners, sorcerors, and witches. Later
on, Linnaeus codified its remarkable properties such The relevant literature was searched using different data-
as dilating the pupils and it was 1830s, when I-atro- bases such as Central library Imam Abdulrahman bin
pine, the pure alkaloid, was extracted from AB plant. Faisal University, PubMed, Google Scalar, Science Direct
It was pure I-atropine that helped as a substantial tool and Google scholar, Web of science. In addition, Jour-
in understanding the physiology of autonomic nervous nals (The American journal of therapeutics, Bali medical
system and lead to identification of the important neu- journal, Human and experimental toxicology, and jour-
rotransmitters in mammalian biological system which is nal of the Royal college of physicians of Edinburgh) and
acetylcholine, (Lee, 2007; Ahmad et al,. 2017b). books (Lippincott’s pharmacology and Katzung’s basic,
Deadly nightshade exerts clinical as well as toxic clinical pharmacology and Neuropathy of Drug Addic-
effects through an anticholinergic mechanism in human tions and Substance Misuse) were also utilized as tools
body, which can affect the central and the peripheral for gathering related information.
nervous system. It is responsible for many symptoms Keywords Searched
such as tachycardia, dry skin, hallucination, mydriasis
and choreoathetoid movements. On the other side it Atropa belladonna, cases reported of Atropa belladonna
may be clinically useful when used to do anamneses in toxicity, Atropine intoxication, Atropa belladonna
clinical examination as well as detailed imaging in cases intoxication, Deadly nightshade intoxication, Anticho-
which are confused with acute cerebrovascular events. linergic toxic syndrome cases and cases of Atropa bel-
Atropa belladonna poisoning should be considered when ladonna poisoning.
diagnosing geriatric patients experiencing hallucination, Review Period
meaningless hand gestures and consciousness. (Saritas
et al., 2014; Ahmad et al., 2017c) This article used a retrospective fourteen (14) years
Atropa belladonna poisoning has been reported in review from year 2003 to 2017.
different age groups however the most dangerous part
Inclusion Criteria
of AB to children is its berries especially younger than
six years’ children, as they have a sweet taste and look Clinical cases included in the review are only related to/
attractive to them. (Milanlioglu, 2011).Toxicity may reported in human subjects only. Any adverse effect or
develop as a result of the ingestion of two to three bays toxicity resulted due to use of atropine in conventional

42 A COMPREHENSIVE REVIEW ON ATROPA BELLADONNA BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

 Hanine Almubayedh et al.

system or herbal system as well as any use related to Toxic Megacolon devolved secondary to OP poisoning
intentional or unintentional ingestion was included in treatment
the study. Furthermore, the toxicity or overdose associ-
An old man was admitted to ER with loss of con-
ated with the use of any part of AB i.e. leaves, fruit and
sciousness. The patient consumed pesticides containing
berries as well as contamination/adulteration of herbs
organophosphate. The treatment plan consisted of atro-
with atropine, were also included.
pine and pralidoxime intravenously however the patient
Exclusion Criteria developed a megacolon following 4 days of atropine
administration. Atropine and pralidoxime tapering was
Any clinical cases reported in animal subjects and in
done and patient was put on a maintenance therapy. The
vitro studies were excluded from the study. Similarly,
serum cholinesterase reached 3209 microkat/1, after 33
any case reporting traditional or general uses of AB
days. (Mostafazadeh et al., 2017).
rather than evidence-based i.e. any clinical case reported
to hospital emergencies or clinics were also excluded
from the study. CLINICAL CASE REPORTED IN 2016
Search Results AB in homeopathic remedies and ACS

The literature search was refined and a total of eleven A 20-days old infant was presented in ER with signs
(11) articles matched the inclusion criteria and they are of seizures and fever, after swallowing a homeopathic
reported in the literature review section as below. agent containing AB for an infantile colic treatment.
Detailed clinical examination revealed and was treated
with Benzodiazepines. In addition i/v antibiotics were
LITERATURE REVIEW administered due to septicemia. Several hours fol-
lowing the monitoring, no signs of fever were found
All the relevant cases were collected, studied, analyzed and the infant recovered from neurological abnor-
and reported after a broad literature review. The cases malities was thus discharged healthy. (Glatstein et al.,
are presented below with respect to the year of publica- 2016).
tion.
CLINICAL CASE REPORTED IN 2014
CLINICAL CASES REPORTED IN 2017
Jimsonweed as a source of suicide
AB causing ACS due to adulteration with marshmallow
roots Glatstein et al, (2016) reported a study of ten adoles-
cent cases with serious ACS and two with a history
Oerlemans et al., reported a case for a patient visiting ER of suicidal attempt. Detailed investigation revealed
with ACS. The history revealed ingestion of hot choco- the use of Jimson weed (atropine containing plant)
late drink with marshmallow root (Althaea officinalis) in half of the patients whereas remaining half of the
for treating cold symptoms. However the lab reports patients used different atropine tablets. Treatment plan
showed ingestion of 20-200 mg of atropine as the herb included Physostigmine, activated charcoal, benzodi-
was contaminated with Ab. The patient after transferring azepines and haloperidol and all the patients were dis-
to ICU was discharged in a healthy state. (Oerlemans et charged healthy. (Glatstein et al., 2014; Ahmad et al.,
al., 2017) 2017a).
ACS due to use of AB berries
Ibrahim karagoz et al, in a study reported a patient case CLINICAL CASE REPORTED IN 2013
from ER with anticholinergic toxic syndrome (ATS) Wild fruit of AB vs consciousness
symptoms (tachycardia, dilated pupils and hot red-
Abdullah Demirhan et al., reported an emergency case
dish extremities and trunk). Upon investigation it was
for a patient presented with symptoms; loss of con-
revealed that the patient used 5 to 6 blackberry like ber-
sciousness and fatigue, red neck and face, dry mouth
ries i.e. AB fruit. Symptoms resolved after application of
and dilated pupils. The care taker for patient revealed
urine catheter and inhibition of oral intake except for
the use of large amount of a forest fruit AB and the
tachycardia. Redness also diminished leaving rashes on
start of symptoms after four hours of ingestion. Gastric
his arms. Sinus tachycardia disappeared during follow-
lavage followed by administration of activated charcoal
up after oral intake resumed. Patient was discharged
(1mg/kg) diminished the symptoms within 24 hours and
healthy from the hospital after the follow-up period.
the patient was discharged healthy. (Demirhan et al.,
(Karagoz et al., 2017)
2013).

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS A COMPREHENSIVE REVIEW ON ATROPA BELLADONNA 43

Hanine Almubayedh et al.

Table 1. Clinical cases reported about Atropa belladonna (nightshade)

Case Form of Atropine Cause of
Age Gender Clinical Manifestation Treatment Protocol
No. Ingested Ingestion
Ingestion of
Female /
1 Althaea officinalis 28 / 27 ACS - contaminated hot
Male
drink
-Tachycardia
Confusion with
2 AB fruit 71 Male -Dilated pupils -
blackberry fruit
-Redness of extremities and trunk

Tapering of Atropine Treatment for OP

3 IV Atropine 52 Male Toxic megacolon
and Pralidoxime poisoning

Homeopathic agent -Seizures Treatment of

4 20 days - -
containing AB -Fever infantile colic

-Physostigmine
Two of patients
Jimsonweed / -Activated charcoal
5 Adolescents - ACS had them as
Atropine Tablets -Benzodiazepine
suicide attempts
-Haloperidol
-Loss of consciousness
-Fatigue -Gastric Lavage
Confusion with
6 AB fruit 49 Female -Redness of face and neck -Activated Charcoal
forest fruit
-Dilated and isochoric pupils -Supportive therapy
-Dryness of mouth
-Confusion
-visual and hearing hallucinations Treatment of
7 11 Female Diazepam
-uncontrollable vomiting jaundice
-incoherent speech
-Flushed warm skin
-Dry tongue
-Activated charcoal Treatment of
-Sudden psychomotor agitation
8 AB Leaves 40 Male -Diazepam chronic peptic
-Disorientation
-Supportive therapy ulcer
-Dilated pupils
-Tachycardia

Confusion with
9 AB Fruit 2 - Central and Peripheral ACS
wild berries

-Tachycardia -Activated charcoal

10 - 48 Male -severe disorientation -Diazepam -
-Aggressiveness -IV Physostigmine
-Tachycardia
-Flushed skin
11 - Children - Neostigmine -
-Meaningless speech
-Mydriasis

CLINICAL CASE REPORTED IN 2012 For treating jaundice the tuberculosis treatment was
stopped. (Berdai et al., 2012)
ATS developed from jaundice treatment
An eleven-year-old girl was administered with AB for CLINICAL CASE REPORTED IN 2011
the sake of treating jaundice developed due to use of
Chronic peptic ulcer treatment causing ACS
rifampicin and isoniazid for lymph node treatment. The
patient developed ATS with symptoms; confusion, vis- A patient was admitted to ER with symptoms; warm and
ual and hearing hallucinations, uncontrollable vomiting, flushed skin, dry tongue, sudden psychomotor agitation,
and incoherent speech. The treatment plan consisted of disorientation, dilated pupils and tachycardia. Patient
diazepam (5 mg) for sedation purpose whereas charcoal history revealed the ingestion of AB leaves for relieving
wasn’t administered as AB was ingested a day before. peptic ulcer. Treatment was successful after administra-

44 A COMPREHENSIVE REVIEW ON ATROPA BELLADONNA BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

 Hanine Almubayedh et al.

tion of activated charcoal, diazepam (10mg) and gastric considered as a toxic one and using the plant without
decontamination. (Milanlioglu, 2011). proper knowledge and guidance may be harmful.
Toxic dose of Atropa belladonna: Atropa belladonna
AB wild barriers causing central and peripheral
was commonly used by professional poisoners, sorcerors
Atropine poisoning symptoms
and witches since ages. Mature fruits and green leaves
A two year old child after eating wild berries was brought have the highest concentration of atropine whereas the
to ER. The plant as presented by his mother was identi- mature fruit is claimed to contain 2 mg of atropine,
fied to be AB whereas the symptoms observed were both (Passos et al., 2016) As per Martindale, the mortal dose
peripheral and central atropine poisoning. Following a of atropine is 10mg (equal to 5 AB fruits) and 100mg
proper treatment, the patient was discharged healthy. (equal to 50 AB fruits) or less for children and adults,
(Laffargue et al., 2011). respectively. Duration of action: ACS symptoms start
usually within one hour after ingestion and Sub-mortal
CLINICAL CASE REPORTED IN 2009 clinical symptoms may continue for 2 days, (Spina et
al., 2007). The severity of ACS/ATS, however, depends
AB Vs ATC upon whether and when medical intervention was taken.
A forty eight year man ingested three handful of AB and (Adamse et al., 2015).
developed symptoms of tachycardia, severe disorienta- Atropine induced psychosis: as mentioned in the lit-
tion and aggressiveness, in the first six hours of inges- erature review, Atropa belladonna intoxications cause
tion. He was treated with diazepam, activated charcoal central ATS symptoms which include hallucinations,
and Physostigmine (continuous therapy) and was recov- confusion and psychosis. Psychosis is induced as a result
ered within two days. (Zimmermann et al., 2009) of decrease in acetylcholine transmission, accompanied
with an increase in dopamine transmission in the Cen-
CLINICAL CASE REPORTED IN 2003 tral nervous system, as their levels are influenced by
each other. (Gaudreau et al., 2005). Atropine induced
Severe to mild AB toxicity symptoms in 49 children. psychosis is explained by the ability of Tropane alka-
AB toxicity was reported in forty nine children’s in loids to rapidly cross the blood brain barrier and affect
a study. They were divided into two groups i.e. sever the CNS functions. Having cholinergic blocking effects,
intoxication symptoms group (6 child’s) and mild to atropine can block M1 receptors (Ardila et al., 1991) in
moderate symptoms group (43 child’s). The most com- the brain causing psychosis by the mentioned mecha-
monly observed symptoms were; tachycardia, flushed nism. Although central and peripheral ATS have been
skin, meaningless speech, and mydriasis. Due to lack of reported in cases of overdose, rare cases are founded to
Physostigmine availability, Neostigmine was used as an cause such symptoms at pharmacological doses in sen-
antidote for treatment. No death cases were reported, sitive subjects. Baker and Farley reported toxic psycho-
(Caksen et al., 2003). sis caused by atropine eye-drops. The patient was pre-
scribed with 1% atropine eye-drops in her right eye for
the treatment of retinal detachment. Following a treat-
DISCUSSION ment of three and half weeks, she developed toxic psy-
chosis and peripheral symptoms of ATS, (Baker, 2010).
Atropa belladonna, known as deadly nightshade, can be Toxic megacolon developed form atropine intoxi-
very toxic. It has an anticholinergic effect on human cation: though incidence of atropine-associated toxic
body which can affect the central as well as the periph- megacolon is very rare, however still few cases have
eral nervous systems. The symptoms and its severity may reported such complication. These case reports sug-
vary among age groups and gender depending upon the gested an involvement of atropine in the manifestation
ingested dose and patients experience anticholinergic of toxic megacolon, (Mostafazadeh et al., 2017; Scharer
toxic syndrome with different symptoms, (Glatstein et et al., 1964; Mann et al., 1977). In the first two cases,
al., 2014; Ahmad et al., 2017a; Ahmad et al., 2017b). toxic megacolon developed after the administration of
However, the most common symptoms reported in anticholinergic agent and was reversed after the dis-
the cases founded in current literature i.e. from 2003- continuation of the anticholinergic agent. Although
2017 includes; tachycardia, seizures, dryness of mouth, the pathophysiological bases of atropine involvement
dilated pupils, hallucinations and confusion. This review in toxic megacolon remain unclear, some theories sug-
underlines the clinical uses as well as any clinical mani- gest that anticholinergic agents, such as atropine, lead to
festations associated with or any toxicity resulted due gastrointestinal peristalsis inactivity and delay intestinal
to use of atropine in any of its form i.e. plant extract, transit time which in turn may have caused toxic mega-
berries, tablets, powder etc. Generally, the plant AB is colon. (Mostafazadeh et al., 2017).

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS A COMPREHENSIVE REVIEW ON ATROPA BELLADONNA 45

Hanine Almubayedh et al.

Memory defects caused by Hyoscine: Hyoscine, also atropine was used as an evidence-based treatment but
known as scopolamine (an active drug in AB plant), has the mechanism of action is unknown yet. It is considered
been widely used in clinical practice for years. However, to be well effective and tolerated at low doses in the
many cases of hyoscine toxicities have been reported. management of low and moderate cases. Atropine has
Hyoscine toxicity has been associated with ATS as been also used to slow the progression of ocular axial
atropine and amnesia. An analysis done after days of elongation and myopia. Audrey et al., studied the effi-
hyoscine intoxication, by Ardila and Moreno in 1991, cacy and safety of atropine in Asian children with myo-
showed significant decrease in logical memory, visual pia. Atropine in this study was very effective and well
reproduction, digits, associative learning which suggest tolerated in slowing down the advancement of myopia
defects in residual memory after hyoscine intoxications, and ocular axial elongation. (Chuang, 2017; Chia et al.,
(Ardila et al., 1991). Although hyoscine induced amne- 2012; Chua et al., 2006).
sia has been reported as an intoxication complication, Managing Smooth muscle spasms hyoscine is an
hyoscine helped in inducing amnesia for testing of the active constituent in the Buscopan formulation as Hyos-
anti-amnesic effect in medications and plants such as cine-n-butyl bromide. Intestinal spasms result from the
Ficus religiosa, (Kaur et al., 2010). cholinergic stimulation of smooth muscle in the GIT,
In our study we reported AB intoxication in retro- which increases its motility and secretions. (Whalen,
spective years i.e. 2003-2017, in adults, children and 2015; Ardila et al., 1991; Zhu et al., 2017). Hyoscine can
adolescents. Almost half of the subjects were adults comfort the pain of bowl and stomach cramps by block-
whereas the other half was children and adolescents. ing the M1 receptors therefore, blocking the cholinergic
Furthermore, intoxication was produced irrespective of effects on the intestinal muscles. In addition, hyoscine is
gender however the subjects mostly affected were male. used as cervical antispasmodic agent in labor whereby
In addition, few of the cases highlighted the use of AB exert effects via decreasing the duration of first stage in
fruit instead of forest fruit by mistake due to similar labor, owing to its anticholinergic effects of the smooth
appearance. One of the cases reported the use of atropine muscles of the uterus. (Sirohiwal et al., 2005).
tablets by adolescent subjects however majority of the Antiemetic effect of hyoscine: hyoscine also blocks
case reports suggests the fact; ACS syndrome was asso- the motility of the smooth muscles as well as their secre-
ciated with the use of AB fruit/plant for treating various tions by its anti-muscarinic action. Having these effects,
diseases such as Jaundice, peptic ulcer, organophosphate hyoscine can be used to control the vomiting and nau-
poisoning and infantile colic. The literature review and sea. A case reported by Brown et al., presented a breast
eleven cases observed during the last fifteen years may cancer patient having nausea and vomiting which were
not be sufficient evidence to claim a plant as a toxic one resistant to the widely available anti-emetics, who was
and disqualify it. As evident in the previously reported treated successfully with hyoscine transdermal patch.
cases, ACS was one of the major drawback observed (Fay and Llio, 2016).
with the use of AB plant however lack of any causal- To conclude; AB ingestion may induce ACS however
ity or death still favor its use as a medicinal plant. The not all of the characteristics of ACS may be found in
reported cases showed the use of Ab/atropine for various few of the AB poisoning cases. The fact is supported
ailments, hence AB plays a major role in various condi- by the presence of hybrid form within AB plant, (Cikla
tions till date, as discussed. et al., 2011). The major aim of current review was to
Atropine as antidote in Organophosphate poisoning: search and report any recently observed cases related
Atropine has a huge therapeutic value and is widely to AB use and explore the most widely observed and
used as an antidote in cases of organophosphate poi- common symptoms of AB toxicity. The aforementioned
soning. Organophosphates are one of the long acting cases suggest two types of clinical manifestation i.
Ach esterase inhibitors used mainly as war gases. (Kat- central nervous system effects (CNS) and ii. Peripheral
zung et al., 2012) Symptoms of OP poisoning manifest nervous system effects (PNS). The symptoms presented
as a result of accumulation of Ach at the nerve junc- with CNS includes; short-term memory loss, ataxia, hal-
tion causing acute cholinergic crisis. Atropine is consid- lucinations, agitated delirium, disorientation, seizures,
ered to be an important agent that reverses central and confusion, psychosis, coma leading towards respiratory
peripheral symptoms of organophosphate poisoning for failure as well as cardiovascular collapse. PNS symp-
its central and peripheral anticholinergic affects. (Dong toms includes; dry mucous membranes, hyperreflexia,
et al., 2017; Kumar et al., 2001; Mustafa et al., 2016). mydriasis with cyclopedia, diminished bowel sounds
Atropine in the management of myopia; Atropine is or ileus, flushed skin, hypertension or hypotension,
a nonselective anticholinergic agent that can be admin- tachycardia and urinary retention. Furthermore, the
istrated locally for controlling mild to moderate myopia, symptoms in children consisted of; lethargy, meaning-
which is one of refractive disorders. In the last decade, less speech, absence of tachycardia and coma. The ACS

46 A COMPREHENSIVE REVIEW ON ATROPA BELLADONNA BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

 Hanine Almubayedh et al.

reported in most of the cases was due to use of AB for Berdai MA, Labib S, Chetouani K, Harandou M (2012). Atropa
different treatment purposes including myopia, smooth belladonna intoxication: a case report. The Pan African Medi-
muscle spasm, jaundice, peptic ulcer and organophos- cal Journal. 11:27.
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managed with charcoal, gastric lavage and Physostig- Oner AF (2003). Deadly nightshade (Atropa belladonna) intox-
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CONCLUSION Tan D (2012). Atropine for the Treatment of Childhood Myopia:
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Chuang AYC (2017). How to effectively manage myopia. Tai-
active drug as well as any conventional medication may
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priately or without any proper medical supervision may (2011). An Atropa belladonna L poisoning with acute subdural
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towards fatal condition. Nightshade) Related Anticholinergic Toxic Syndrome: A Case
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CONFLICT OF INTERESTS Dong H, Weng YB, Zhen GS, Li FJ, Jin AC, Liu J (2017). Clinical
emergency treatment of 68 critical patients with severe organ-
No conflict of interest exists among the authors. ophosphorus poisoning and prognosis analysis after rescue.
Medicine (Baltimore). 96(25): e7237.
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hyoscine hydrobromide patch. BMJ Supportive & Palliative
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