Scopolamine hydrobromide overdose
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Anticholinergic syndrome: case report An inadvertent scopolamine hydrobromide overdose led to anticholinergic syndrome in a 42-year-old man with a history of gastroparesis of unknown origin for which he had been prescribed domperidone 20mg four times daily. The man, a truck driver, omitted to take his lunchtime dose of domperidone after leaving his medication at home. While at work, he took scopolamine hydrobromide that belonged to a friend, ingesting four tablets as a single 1.2mg dose. He later took a single dose of domperidone 60-80mg due to increasing nausea. Approximately 5-6 hours after taking scopolamine hydrobromide and 3 hours after taking domperidone, he exhibited inappropriate behaviour and became confused and agitated. The man presented to the emergency department in an altered state of consciousness. He was disoriented and agitated, appeared to be responding to auditory and visual hallucinations, and was trying to touch imaginary objects. He had a Glasgow Coma Scale score of 13, a heart rate of 100 beats/min, a respiratory rate of 20 breaths/min, a temperature of 37.8°C and a BP of 123/74mm Hg. A physical examination revealed dilated pupils, warm, dry skin and repeated myoclonic jerking of the limbs and jaw. The man was diagnosed with anticholinergic toxicity secondary to scopolamine hydrobromide. The man received midazolam for the management of agitation and myoclonic jerking. His level of consciousness decreased to a Glasgow Coma Scale score of 3 and he was intubated. Following admission to the intensive care unit where he was sedated with propofol, the man rapidly improved and was extubated 3 hours later. He was discharged with slightly blurred vision. Author comment: "Application of the Naranjo probability scale to our case report assigns the likelihood that the symptoms of anticholinergic toxicity were caused by scopolamine hydrobromide as "probable"." Corallo CE, et al. Anticholinergic syndrome following an unintentional overdose of scopolamine. Therapeutics and Clinical Risk Management 5: 719-723, No. 1, Jan 803013478 2009 - Australia
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Reactions 8 May 2010 No. 1300
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