Management of Datura Poisoning

Immediate Recognition and Stabilization

• Airway management takes absolute priority, with intubation immediately for coma, respiratory depression, or inability to protect airway, as recommended by the American Heart Association 1
• Contact poison control immediately for expert toxicology guidance, available at 1-800-222-1222 in the US, as suggested by the American College of Medical Toxicology 1, 2

Specific Pharmacologic Management

• Administer benzodiazepines immediately for seizures, severe agitation, or delirium, with diazepam as first-line and midazolam as alternative, according to the American Heart Association with a Class 1, Level C-LD recommendation 1, 2, 3
• Physostigmine is the definitive antidote for severe anticholinergic toxicity from Datura poisoning, with indications including severe delirium or hallucinations not controlled by benzodiazepines, coma, life-threatening hyperthermia, and seizures refractory to benzodiazepines, as recommended by the American College of Medical Toxicology 1, 2

Monitoring and Complications Management

• Do not delay treatment waiting for toxicology confirmation, as diagnosis is clinical based on anticholinergic toxidrome, and treatment should be initiated promptly, as recommended by the American College of Medical Toxicology 1, 2