Presumed Central Anticholinergic Syndrome from Inadvertent Intravenous Hyoscine Hydrobromide (Scopolamine) Injection

Abstract

We present a case of presumed central anticholinergic syndrome due to a drug administration error. A 35-year-old woman was slow to emerge from anaesthesia for laparoscopic biliary surgery. Postoperative neurological and metabolic abnormalities were later diagnosed as central anticholinergic syndrome. Only after resolution of the clinical problems did the drug error origin of the syndrome become apparent. It was realized that hyoscine hydrobromide (scopolamine) had been inadvertently administered intraoperatively for biliary relaxation, instead of hyoscine butylbromide. This case report describes central anticholinergic syndrome and highlights potential problems involved for anaesthetists administering drugs they do not commonly use.

First Do No Harm… Terminal Restlessness or Drug-Induced Delirium

“…However, it may cause agitation, delirium, excitement and hyperpyrexia due to an absolute or relative reduction in cholinergic activity in the central nervous system (CNS), possibly due to an antagonistic effect to arousal at a hypothalamic and brainstem level. 21 Hyoscine hydrobromide, even at very low doses, is commonly associated with cognitive changes, including hallucinations and overt delirium. 12 Hyoscine hydrobromide can be used topically as a transdermal patch or subcutaneously by injection or syringe driver.…”

Unveiling the Dark Side of Datura in Pediatric Poisoning With Insights From Jordanian Experience

“…15 Scopolamine, which crosses the blood-brain barrier, is responsible for the neurological effects associated with Datura poisoning including delirium, drowsiness, agitation, and dementia. 16 The signs and symptoms of Datura poisoning are commonly referred to as the 10 D's: (1) dryness of mouth, thirst, and slurred speech; (2) dysphagia; (3) dilated pupils; (4) diplopia; (5) dry hot skin with flushing and hyperpyrexia; (6) drunken gait (ataxia), hyperreflexia, and convulsions; (7) delirium with hallucinations, agitation, amnesia, and incoherence; (8) delusions; (9) dysuria, urinary retention, and bladder distention; and (10) death preceded by tachycardia, arrhythmias, coma, and respiratory depression. 17 Datura toxicity can result from confusion with other foods leading to accidental ingestion (particularly in children) or overdose when used as a traditional remedy.…”

“…Managing its toxicity depends on the severity of symptoms and involves monitoring, supportive care, decontamination, control of agitation and seizures, and antidotes administration 15 . Scopolamine, which crosses the blood-brain barrier, is responsible for the neurological effects associated with Datura poisoning including delirium, drowsiness, agitation, and dementia 16 …”