Atropa belladonna (Deadly nightshade)
Atropa belladonna is a classic cause of anticholinergic (antimuscarinic) poisoning. The plant contains tropane alkaloids (atropine, hyoscyamine, scopolamine) that antagonise muscarinic receptors, producing a mixed central and peripheral anticholinergic syndrome.
Emergency clinicians should recognise the toxidrome, follow standard poisoned‑patient priorities, and involve poisons specialists (TOXBASE / NPIS) early - physostigmine is an effective but specialist antidote and is not routinely held in all EDs (RCEM/NPIS guidance).
Epidemiology and sources of exposure
- The plant is native to Europe and Western Asia and is found elsewhere after introduction.
- All plant parts are poisonous; roots and leaves commonly have the highest alkaloid concentrations.
- Berries are the classic paediatric hazard because they are sweet and attractive.
- Tropane alkaloids can be detected as contaminants in food and herbal products; small accidental ingestions, especially in children, can be clinically important (Food Standards Agency monitoring).
Pathophysiology
- Toxic alkaloids: atropine, hyoscyamine and scopolamine.
- Mechanism: competitive blockade of muscarinic (M1-M5) receptors.
- Scopolamine tends to produce relatively greater central nervous system effects (delirium, hallucinations).
- Clinical severity depends on dose, plant part, route and co‑ingestants; effects can be prolonged after ingestion of plant material.