Diminished Consciousness in a Woman Following an Unsuspected Scopolamine Overdose

Scopolamine is used clinically, but it is also used as a recreational drug and as an incapacitating drug in sexual crimes and robberies. In this paper, the authors report the case of a woman with a diminished consciousness following an unsuspected overdose with scopolamine and review published articles on scopolamine poisoning that included concentrations in biological samples. Scopolamine was identified in the patient's serum and urine samples collected 1 h post-admission to intensive care unit at concentrations of 8.4 ng/mL and 62,560 ng/mL (169,539 ng/mg creatinine), respectively. In non-fatal cases, the median [interquartile range] of serum scopolamine levels was 1.9 [2.1] ng/mL. The serum concentration found in our case would explain the abrupt clinical presentation suffered by the patient. Scopolamine in urine could be detected up to 48 h after admission. This report illustrates that broad toxicology screening, including scopolamine, should be considered when patients with diminished consciousness are attended after ruling out infection or cerebrovascular disease. This can play an important role in identifying this potentially life-threatening etiology.

Automated summary

Scopolamine is a versatile drug used for various purposes, but overdose can lead to diminished consciousness. The concentration of scopolamine in serum can explain sudden clinical presentations, while its presence in urine can be detected up to 48 hours. Therefore, screening for scopolamine and other toxins is crucial in identifying potentially life-threatening causes.