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1.
Lakartidningen ; 1162019 Sep 25.
Artigo em Sueco | MEDLINE | ID: mdl-31573667

RESUMO

Sometimes it is suspected that people have been involuntary exposed to drugs, usually by spiked drinks. A young woman was transported to an emergency department by ambulance. Her clinical symptoms (decreased consciousness, mydriasis, confusion, hallucinations and urine retention) indicated anticholinergic syndrome that was effectively treated with the antidote physostigmine. A urine sample tested negative for common narcotic drugs and alcohol, but an extended toxicological analysis of the urine revealed the presence of the alkaloid scopolamine. Scopolamine occurs naturally in Solanaceae plants and is used in some medications. The woman reported that the symptoms had appeared soon after she was offered tea by a male acquaintance. The analytical results along with the woman's story indicated that she had been subjected to a drug-facilitated crime. The results further demonstrate that in suspected cases of involuntary drug exposure, testing should cover a wide panel of relevant drugs, otherwise poisoning may be missed.


Assuntos
Antagonistas Colinérgicos , Escopolamina , Detecção do Abuso de Substâncias , Adolescente , Adulto , Síndrome Anticolinérgica/tratamento farmacológico , Síndrome Anticolinérgica/etiologia , Antídotos/uso terapêutico , Antagonistas Colinérgicos/envenenamento , Antagonistas Colinérgicos/urina , Cromatografia Líquida de Alta Pressão , Vítimas de Crime , Feminino , Humanos , Espectrometria de Massas , Fisostigmina/uso terapêutico , Escopolamina/envenenamento , Escopolamina/urina , Detecção do Abuso de Substâncias/métodos , Detecção do Abuso de Substâncias/normas , Adulto Jovem
2.
J Emerg Med ; 53(4): 520-523, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28756934

RESUMO

BACKGROUND: Scopolamine is a potent anticholinergic compound used commonly for the prevention of postoperative nausea and vomiting. Scopolamine can cause atypical anticholinergic syndromes due to its prominent central antimuscarinic effects. CASE REPORT: A 47-year-old female presented to the emergency department (ED) 20 h after hospital discharge for a right-knee meniscectomy, with altered mental status (AMS) and dystonic extremity movements that began 12 h after her procedure. Her vital signs were normal and physical examination revealed mydriasis, visual hallucinations, hyperreflexia, and dystonic movements. Laboratory data, lumbar puncture, and computed tomography were unrevealing. The sustained AMS prompted a re-evaluation that revealed urinary overflow with 500 mL of retained urine discovered on ultrasound and a scopolamine patch hidden behind her ear. Her mental status improved shortly after patch removal and physostigmine, with complete resolution after 24 h with discharge diagnosis of scopolamine-induced anticholinergic toxicity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although therapeutically dosed scopolamine transdermal patches rarely cause complications, incomplete toxidromes can be insidiously common in polypharmacy settings. Providers should thoroughly evaluate the skin of intoxicated patients for additional adherent medications that may result in a delay in ED diagnosis and curative therapies. Our case, as well as rare case reports of therapeutic scopolamine-induced anticholinergic toxicity, demonstrates that peripheral anticholinergic effects, such as tachycardia, dry mucous membranes, and hyperpyrexia are often not present, and incremental doses of physostigmine may be required to reverse scopolamine's long duration of action. This further complicates identification of the anticholinergic toxidrome and diagnosis.


Assuntos
Síndrome Anticolinérgica/diagnóstico , Antagonistas Colinérgicos/envenenamento , Síndrome Anticolinérgica/etiologia , Antagonistas Colinérgicos/uso terapêutico , Distonia/etiologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Alucinações/etiologia , Humanos , Meniscectomia/efeitos adversos , Meniscectomia/normas , Pessoa de Meia-Idade , Midríase/etiologia , Período Pós-Operatório , Escopolamina/envenenamento , Escopolamina/uso terapêutico , Adesivo Transdérmico
4.
Forensic Sci Int ; 274: 79-82, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28237441

RESUMO

The use of scopolamine as an incapacitating drug, in sexual crimes and robberies, has been known for many decades. However, blood concentrations and doses of scopolamine in those cases are largely unknown. Here we present the toxicological results of one fatal and two non-fatal cases in a series of scopolamine-facilitated robberies. In the fatal case, the concentration of scopolamine in heart blood was 0.30mg/L, about 3000 times higher than the average therapeutic level of 0.0001mg/L (for one dermal patch). In femoral blood, the concentration of scopolamine was much lower (0.0048mg/L), but still 50 times higher than therapeutic levels. The scopolamine concentration in the stomach was very high (20mg/kg) as compared to the heart blood and femoral blood, which explains the very high concentration in heart blood by postmortem leakage from the stomach. In the non-fatal case, the scopolamine concentration in serum, obtained 23h after the incident, was 0.00035mg/L. The estimated concentration of scopolamine at the time of the incident is 0.0035mg/L. In the other non-fatal case, scopolamine was detected in urine and in hair.


Assuntos
Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/envenenamento , Escopolamina/efeitos adversos , Escopolamina/envenenamento , Roubo , Antagonistas Colinérgicos/análise , Conteúdo Gastrointestinal/química , Cabelo/química , Humanos , Masculino , Pessoa de Meia-Idade , Mudanças Depois da Morte , Escopolamina/análise
8.
Artigo em Inglês | MEDLINE | ID: mdl-24823431

RESUMO

Tropane alkaloids (TAs) are toxic secondary metabolites produced by plants of, inter alia, the genera Datura (thorn apple) and Atropa (deadly nightshade). The most relevant TAs are (-)-L-hyoscyamine and (-)-L-scopolamine, which act as antagonists of acetylcholine muscarinic receptors and can induce a variety of distinct toxic syndromes in mammals (anti-cholinergic poisoning). The European Union has regulated the presence of seeds of Datura sp. in animal feeds, specifying that the content should not exceed 1000 mg kg(-1) (Directive 2002/32/EC). For materials that have not been ground, visual screening methods are often used to comply with these regulations, but these cannot be used for ground materials and compound feeds. Immunological assays, preferably in dipstick format, can be a simple and cost-effective approach to monitor feedstuffs in an HACCP setting in control laboratories. So far no reports have been published on immunoassays that are capable of detecting both hyoscyamine and scopolamine with equal sensitivity and that can be used, preferably in dipstick format, for application as a fast screening tool in feed analysis. This study presents the results obtained for the in-house and inter-laboratory validation of a dipstick immunoassay for the detection of hyoscyamine and scopolamine in animal feed. The target level was set at 800 µg kg(-1) for the sum of both alkaloids. By using a representative set of compound feeds during validation and a robust study design, a reliable impression of the relevant characteristics of the assay could be obtained. The dipstick test displayed similar sensitivity towards the two alkaloids and it could be concluded that the test has a very low probability of producing a false-positive result at blank level or a false-negative result at target level. The assay can be used for monitoring of TAs in feedstuffs, but has also potential as a quick screening tool in food- or feed-related poisonings.


Assuntos
Ração Animal/análise , Contaminação de Alimentos/análise , Hiosciamina/análise , Imunoensaio/métodos , Escopolamina/análise , Ração Animal/toxicidade , Animais , Atropa/química , Atropa/envenenamento , Bovinos , Datura stramonium/química , Datura stramonium/envenenamento , União Europeia , Reações Falso-Negativas , Reações Falso-Positivas , Contaminação de Alimentos/legislação & jurisprudência , Hiosciamina/envenenamento , Imunoensaio/normas , Escopolamina/envenenamento , Sementes/química , Sementes/envenenamento
9.
BMJ Case Rep ; 20112011 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-22707464

RESUMO

Topical hyoscine hydrobromide cross-contamination can occur between individuals and the anticholinergic effects of hyoscine can lead to diagnostic confusion.


Assuntos
Antagonistas Colinérgicos/envenenamento , Diplopia/induzido quimicamente , Escopolamina/envenenamento , Adulto , Humanos , Masculino
10.
Clin Toxicol (Phila) ; 48(2): 143-5, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20136480

RESUMO

BACKGROUND: Anticholinergic plants contain a variety of alkaloids that are toxic if ingested. Datura innoxia belongs to the family of Solanaceae and contains two main toxic alkaloids, atropine and scopolamine. CASE SERIES: In this study we report the case series of seven individuals who were admitted to two different hospitals of Athens with an anticholinergic syndrome. All symptoms manifested after consumption of cooked vegetables (blites). INVESTIGATION: The investigation of the cases revealed that among the vegetables there was also Datura innoxia, which has a similar appearance to blites. Urine and plasma samples of the seven patients, as well as a sample of cooked vegetables, were analyzed with gas chromatography-mass spectrometry. Atropine and scopolamine were confirmed in all urine and vegetable samples, but not in plasma probably because of the delay in sample collection. The urine samples of all patients contained atropine in concentrations between 67.1 and 691.7 ng/mL, while urine concentrations of scopolamine ranged from 32.4 to 186.4 ng/mL. The concentrations of atropine and scopolamine in the cooked vegetables were found to be 0.8 and 1.2 microg/g, respectively. CONCLUSION: All patients recovered completely, although some required mechanical ventilation. The investigation and the presentation of this case series illustrate not only mass intoxication with D. innoxia, but also the utility of analytical toxicology. It also illustrates the dangers of collection of vegetables in the wild.


Assuntos
Datura/envenenamento , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/etiologia , Intoxicação por Plantas/etiologia , Atropina/farmacocinética , Atropina/envenenamento , Datura/química , Feminino , Doenças Transmitidas por Alimentos/fisiopatologia , Cromatografia Gasosa-Espectrometria de Massas , Grécia/epidemiologia , Humanos , Masculino , Intoxicação por Plantas/fisiopatologia , Escopolamina/farmacocinética , Escopolamina/envenenamento , Verduras/normas
11.
Clin Toxicol (Phila) ; 47(9): 889-93, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19821638

RESUMO

OBJECTIVE: An epidemic of scopolamine poisonings occurred in Oslo in 2008 among users of illicit drugs, caused by fake Rohypnol pills. The clinical features, diagnostic process, and handling of the epidemic are presented. METHODS: Suspected cases of scopolamine poisoning were extracted by reviewing registration forms from an ongoing prospective clinical study of acute poisonings in Oslo. Medical records of extracted contacts were examined and cases included according to specified clinical criteria. RESULTS: Forty-four cases of probable scopolamine poisoning were registered. Main clinical features were mydriasis, visual hallucinations, plucking behavior, agitation, and coma. No clinical diagnosis of anticholinergic syndrome was made prior to forensic analysis of the tablets, the most frequent diagnosis up to this point being unspecified drug-induced psychosis. Later in the epidemic, scopolamine poisoning became the dominating diagnosis. Ten patients were admitted to psychiatric hospitals, the rest recovered in medical units, or left health care against medical advice. DISCUSSION: Scopolamine poisonings are rare, but the resulting anticholinergic syndrome is well described. The syndrome was not recognized until the forensic analysis result strikingly changed how the patients were diagnosed and handled. A unique aspect of this epidemic was the intoxicating agent being scopolamine-containing tablets looking like Rohypnol, sold and used under the impression of being the latter. CONCLUSION: Recognizing the anticholinergic syndrome is important to provide proper treatment. Forensic analysis was the key to correct diagnosis in this outbreak, demonstrating its importance in verifying an epidemic of poisoning by fake drugs.


Assuntos
Flunitrazepam/normas , Antagonistas Muscarínicos/envenenamento , Escopolamina/envenenamento , Adulto , Contaminação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Estudos Retrospectivos , Síndrome , Adulto Jovem
13.
Drug Saf ; 30(5): 375-8, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17472417

RESUMO

An outbreak of hyoscine hydrobromide toxicity was detected through the Australian pharmacovigilance system. The unexpectedly wide variation in hyoscine hydrobromide content between individual tablets within single packets created difficulties in initially explaining the clinical experiences. Strict time requirements for review of incoming adverse drug reaction reports and close involvement of the highly skilled national drug regulatory laboratory resulted in early identification of the cause of the outbreak and led in turn to the identification of malpractice by the contract manufacturer.


Assuntos
Contratos/legislação & jurisprudência , Indústria Farmacêutica/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Escopolamina/envenenamento , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Austrália , Criança , Controle de Medicamentos e Entorpecentes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enjoo devido ao Movimento/prevenção & controle , Escopolamina/administração & dosagem , Comprimidos
14.
Rinsho Byori ; 54(10): 1003-7, 2006 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-17133988

RESUMO

We encountered a patient in a restless excitable state after eating boiled jimson weed grown in the patient's garden. The patient mistook the weed for Angelica keiskei. Pupillary dilation (7/7mm), weak light reflex, body temperature of 37 degrees C, respiratory frequency of 19/min, blood pressure of 138/88 mmHg, pulse rate of 108/min, and hot feeling were observed. No abnormalities nor special findings were detected by general examination of the peripheral blood, biochemical examination of the blood, general examination of the urine, or electrocardiography. Atropine and scopolamine, which are tropane alkaloids, were detected by the GC/MS. The retention time of atropine-TMS was 17.0 min, and the mass spectra were m/z 124, 82, and 140. The retention time of scopolamine-TMS was 17.7 min, and the mass spectra were m/z 138, 108, 154 and 375. At the time of consultation, the serum concentrations of atropine and scopolamine were 31.3 ng/ml, and 30.6 ng/ml, respectively, and decreased to 6.7 ng/ml and 8.5 ng/ml, respectively, after 2 hours. The patient underwent injection of activated carbon after gastrolavage with 2,000 ml warm water, and neostigmine was administered. The patient awoke the following morning, and was discharged with mild pupillary dilation 2 days after poisoning.


Assuntos
Atropina/análise , Atropina/envenenamento , Datura stramonium/envenenamento , Escopolamina/análise , Escopolamina/envenenamento , Adulto , Atropina/sangue , Atropina/urina , Carvão Vegetal/administração & dosagem , Datura stramonium/química , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Lavagem Gástrica , Conteúdo Gastrointestinal/química , Humanos , Escopolamina/sangue , Escopolamina/urina
15.
Fa Yi Xue Za Zhi ; 22(4): 285-7, 2006 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-17080669

RESUMO

OBJECTIVE: To separate and determine scopolamine from the food in a poisoning case by GC/MS. METHODS: The scopolamine was determined by GC/MS/El used CP5860(CP-sil8CB) column (30 mx 0.25 mmx 0.33 microm) with liquid- liquid extraction. RESULTS: The deny scopolamine was found in the case sample, and the chromatographic separation of the peaks is fine. CONCLUSION: The method is accurate and reliable.


Assuntos
Doenças Transmitidas por Alimentos/etiologia , Medicina Legal/métodos , Cromatografia Gasosa-Espectrometria de Massas/métodos , Escopolamina/análise , Escopolamina/envenenamento , Alucinações/induzido quimicamente , Alucinações/diagnóstico , Humanos , Masculino , Psicoses Induzidas por Substâncias/diagnóstico , Psicoses Induzidas por Substâncias/etiologia , Escopolamina/química , Sensibilidade e Especificidade , Solanaceae/química , Solventes/química
18.
Ann Pharmacother ; 39(1): 173-6, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15572604

RESUMO

OBJECTIVE: To report a case in which ingestion of moonflower seeds resulted in antimuscarinic intoxication. CASE SUMMARY: An 18-year-old man was found at a local convenience store hallucinating and incoherent. Upon presentation to the emergency department, his signs and symptoms included tachycardia, confusion, dilated pupils, and dry, flushed, hot skin. He was admitted to the intensive care unit. Hallucinations and symptoms resolved within 36-48 hours after hospitalization. The patient then reported that he had ingested moonflower seeds. He recovered and was released 4 days after admission. DISCUSSION: Based on the patient's description and clinical presentation, the moonflower seeds were believed to be Datura inoxia. This species of plant is similar to jimson weed, or Datura stramonium. These plants are known to contain high concentrations of anticholinergic substances; ingestion can result in anticholinergic intoxication. Signs and symptoms that commonly occur include hallucinations, tachycardia, dilated pupils, and disorientation. In our patient, use of the Naranjo probability scale indicated a possible relationship between the moonflower seed ingestion and the patient's signs and symptoms. CONCLUSIONS: Ingestion of the Datura species can result in severe toxicity. Each plant varies in the concentrations of alkaloid substances. For this reason, it is very important for individuals to become educated on the toxicities and potential risks associated with recreational use of these plants.


Assuntos
Datura/efeitos adversos , Antagonistas Muscarínicos/envenenamento , Intoxicação por Plantas/complicações , Sementes/envenenamento , Adolescente , Atropina/química , Datura/química , Humanos , Masculino , Estrutura Molecular , Antagonistas Muscarínicos/química , Escopolamina/química , Escopolamina/envenenamento , Sementes/química , Transtornos Relacionados ao Uso de Substâncias
19.
Clin Toxicol (Phila) ; 43(7): 861-5, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16440514

RESUMO

We report three patients with anticholinergic poisoning caused by the substitution of hyoscine hydrobromide for hyoscine butylbromide in preparations compounded by two different pharmacists. The patients took the preparations for gastrointes tinal discomfort and presented with altered mental status tachycardia, facial flushing, dilated pupils, and dry skin shortly after the ingestion. In one patient the intoxication was initially not recognized and he was treated as suffering from an acute cerebrovascular accident. Two patients experienced long-lasting effects such as decreased ability to concentrate, memory dis turbances, tremor, and photo- and phonophobia. It was obviously impossible to elucidate the exact nature of the relationship between the intoxication and these long-lasting complaints. Information from the Belgian poison control center revealed that cases of substitution error with hyoscine hydrobromide are not unique The Belgian authorities issued a warning to all pharmacists.


Assuntos
Erros de Medicação , Antagonistas Muscarínicos/envenenamento , Escopolamina/envenenamento , Adulto , Overdose de Drogas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Escopolamina/administração & dosagem , Resultado do Tratamento
20.
Arch Kriminol ; 210(1-2): 16-21, 2002.
Artigo em Alemão | MEDLINE | ID: mdl-12365330

RESUMO

The cause of drowning deaths in good swimmers may be difficult to solve. After homicide, suicide and other kinds of immersion deaths have been ruled out, not only alcohol and narcotics, but also other psychotropic substances such as thornapple and angel's trumpet should be taken into consideration--at least in adolescents and young adults. The article reports on an accidental death by drowning under the influence of tropane alkaloids after consumption of a decoction of the flowers of angel's trumpet.


Assuntos
Acidentes/legislação & jurisprudência , Atropina/envenenamento , Afogamento/patologia , Extratos Vegetais/envenenamento , Escopolamina/envenenamento , Solanaceae/envenenamento , Chá/envenenamento , Adolescente , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Detecção do Abuso de Substâncias
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