Ali AHISKALIOĞLU, Hüsnü KÜRŞAD, Ayşenur DOSTBİL, Elif ORAL, İlker İNCE, İbrahim Hakkı TÖR

Atropa Belladonna ile Gelişen Antikolinerjik Sendrom

Atropa belladonna genellikle çorak ve taşlık zeminde yetişen, yeşil yapraklar ve meyvesinde yüksek oranda belladonna alkaloidleri içeren bir bitkidir. Yüksek oranda alınması antikolinerjik sendroma neden olabilir Antikolinerjik ilaçlar asetilkolinin, muskarinik asetilkolin reseptörlerine bağlanmasını yarışmalı olarak inhibe eder ve antimuskarinik ajanlar olarak adlandırılır. Muskarinik reseptörler periferik postganglionik kolinerjik sinirlerde düz kaslarda (barsak, bronşiyal ve kalp), sekretuar glandlarda, gözün silier cisminde ve santral sinir sisteminde bulunur. Antikolinerjik intoksikasyonunun klinik bulguları; kutanöz vazodilatasyon, anhidrozis, anhidrotik hipertermi, nonreaktif midriazis, deliryum, halüsinasyon, üriner retansiyon, taşikardi ve azalmış barsak sesleridir. Bu olgu sunumunda atropa belladonna ile zehirlenen altmış iki yaşında bir hasta sunulmuştur.

Atropa Belladonna Related Anticholinergic Syndrome

Atropa belladonna is a plant species that grows in barren and stony lands. Green leaves and fruits of deadly nightshade contain high concentration of belladonna alkaloids. Overconsumption of that plant causes anticholinergic syndrome. Anticholinergic drugs competitively inhibit binding of the neurotransmitter acetylcholine to muscarinic acetylcholine receptors, and are called antimuscarinic agents. Muscarinic receptors are found on peripheral postganglionic cholinergic nerves in smooth muscle (intestinal, bronchial, and cardiac), the secretory glands the ciliary body of the eye, and the central nervous system. Clinical findings of anticholinergic intoxication are; cutaneus vasodilation, anhidrosis, anhydrotic hyperthermia, nonreactive mydriasis, delirium, hallucinations, urinary retantion, tachycardia and decreased bowel sounds. A sixty two years old patient who was poisoned by atropa belladonna is presented in that case report.

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1. Caksen H, Odabaş D, Akbayram S, Cesur Y, Arslan S,Uner A, Oner AF. Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children. Hum Exp Toxicol. 22:665-8, 2003.
2. Lange A, Toft P. Poisoning with nightside, Atropa belladona. Ugeskr Laeger. 152: 1096, 1990.
3. Perlik-Gattner I. Atropa belladona poisoning suggesting severe post - traumatic brain damage. Przegl Lek 54: 464-65, 1997.
4. Southgate HJ, Egerton M, Dauncey EA. Lessons to belearned: a case study approach. Unseasonal severe poisoning of two adults by deadly nightside (Atropa belladonna ). J R Soc Health 120: 127-30, 2000.
5. Trabattoni G, Visintini D, Terzano GM, Lechi A. Accidental poisoning with deadly nightshade berries: a case report. Hum Toxicol, 3: 513-/16. 1984
6. Fidan Tulin, Kirpinar Ismet. Psychiatric Aspects of a Case with Deadly Nightshade Intoxication. Journal of academic emergency medicine. 10:86-88, 2011
7. Schneider F, Lutun P, Kintz P, Astruc D, Flesch F, Tempe JD: Plasma and urine concentrations of atropine after the ingestion of cooked deadly nightshade berries. J Toxicol Clin Toxicol 34:113-17, 1996.
8. Cengiz Demir, Cumhur Dülger, Rafet Mete, Şevket Arslan, İmdat Dilek.Atropa Belladonna İle Zehirlenme: Bir Olgu Sunumu Van Tıp Dergisi: 13 :61-63, 2006
9. Tekelioğlu, İsa Yıldız, Tanzer Korkmaz, Murat Bilgi, Akcan Akkaya, Hasan Koçoğlu. Atropa Belladonna (Güzel Avrat Otu) Meyvesi ile İlişkili Antikolinerjik Toksik Sendrom: Bir Olgu Sunumu. Abdullah Demirhan, Ümit Yaşar Turk J Anaesth Reanim. 41: 226-8, 2013
10. Synder RD. Bacterial infections of the nervous system. In Swaiman KF, Ashwal S eds. Pediatric neurology. Principles & practice, third edition. St Louis: Mosby, 1999: 981-1000.
11. Fenichel GM. Clinical pediatric neurology. A sign and symptoms approach, third edition. Philadelphia: WB Saunders, 1997.
12. Mohamed Adnane Berdai1, Smael Labib, Khadija Chetouani, Mustapha Harandou. Atropa Belladonna intoxication: a case report. Pan African Medical Journal. 2012; 11:72
13. .Joshi P, Wicks AC, Munshi SK. Recurrent autumnal psychosis. Postgrad Med J. 79:239-240, 2003
14. Cikla U, Turkmen S, Karaca Y, Ayaz AF, Turedi S, Gunduz A. An Atropa belladonna L poisoning with acute subdural hematoma. Hum Exp Toxicol. 30: 1998-2001, 2011
15. Laffargue F, Oudot C, Constanty A, Bedu A, Ketterer-Martinon S. Deadly nightshade (Atropa belladonna) intoxication in a 2-yearold child. Arch Pediatr. 18:186-8, 2011