Clinical records

Patient 1

A 73-year-old woman presented to a Western Australian metropolitan hospital in September 2007. She described having a dry mouth, lethargy and difficulty mobilising about an hour after eating two scones prepared with lupin flour. On arrival at hospital, her condition was much improved, and lethargy and dry mucous membranes were the only symptoms recorded. However, the treating doctor was not aware of the potential for anticholinergic effects, and may not have been looking for specific anticholinergic features. The patient was discharged several hours after presenting; her symptoms were attributed to a presumed allergic reaction.

Patient 2

A 66-year-old woman presented to the same hospital 3 days later in September 2007. This patient had developed symptoms 15 minutes after eating pancakes prepared with lupin flour. She reported more typical anticholinergic features of blurred vision, dry mouth, lethargy and light-headedness. On examination she was found to have a sinus tachycardia of 100 beats/min, mildly dilated pupils, dry mouth, blurred vision and a residual bladder volume of 590 mL after voiding, indicating a moderate degree of urinary retention. Anticholinergic syndrome after ingesting lupins was diagnosed. She was kept in hospital overnight and her symptoms had resolved by morning.

Recognition of a possible link

After Patient 2 was diagnosed with anticholinergic syndrome caused by eating lupins, consulting physicians recalled that Patient 1 had also reported lupin consumption. After reviewing the clinical notes from Patient 1, it was recognised that this patient also had anticholinergic symptoms and that the two cases might be linked.