Purpose
The purpose of this fact sheet is to alert alert clinicians who receive infant presentations
about the possibility of belladonna toxicity following ingestion of certain ‘colic preparations’.
Situation
In separate cases, two infants have presented to a Brisbane metropolitan hospital with
presumed belladonna toxicity following ingestion of a ‘colic preparation’ purchased online.
Similar incidents have been reported interstate.
Background
‘Colic’ is an out-dated term used to describe excessive crying and popular, ‘colic treatments’
such as gripe water, herbal remedies and homeopathy are not indicated1
. Some ‘colic
preparations’ contain belladonna which poses significant additional risks. Belladonna is a
plant that contains compounds that produce anticholinergic activity. Natural variation and
extraction methods may result in variability in the concentration of these compounds when
used in unregulated medicines.
Signs and symptoms of belladonna toxicity include erythematous flushed skin, dry skin, dry
mouth, mydriasis, tachycardia, urinary retention, gastrointestinal ileus, raised temperature,
agitation, drowsiness, floppiness, poor feeding and occasionally seizures2
. Onset of toxicity
is usually within 30 minutes to 4 hours; symptoms may be significantly delayed or prolonged
due to decreased gastric motility and may vary due to frequent and repeated dosing
Assessment
• Colic preparations’ include a broad range of products from home remedies, products
available over the counter (e.g. gripe water) through to compounded products; it is
important to obtain specific information about the ingredients.
• Heightened suspicion of belladonna toxicity is warranted in infants presenting with the
toxidrome described above where ‘colic preparations’ have been identified as part of
the medication history process.
• The Poisons Information Centre may be contacted on 131126 for advice on managing
patients presenting with belladonna toxicity.
Recommendations
1. Exercise heightened awareness of the possibility of belladonna toxicity following
ingestion of colic preparations.
2. Ensure specific information regarding the formulation of ‘colic preparations’ is obtained
during the history taking.
3. Report any suspected incidents of belladonna toxicity to the Therapeutic Goods
Administration (TGA) and local clinical incident reporting systems.
4. Table this Factsheet at appropriate meetings for consideration.