Toxicodynetics Of An Acute Overdose Resulting From Malicious Inhalation Of Scopolamine

Aim. - To report a case of malicious poisoning by scopolamine from the perspective of the toxicodynetics of intoxication.Patient and methods. - Clinical data were collected on a healthy narcotic-free patient according to the method of toxicodynetics. Toxicological analyzes were performed by liquid chromatography-tandem mass spectrometry.Results. - The dose was unknown, as it was administered through an impregnated handkerchief inhalation in front of the nose, (i) the delay between inhalation and disability signs was about 10 min, (ii) then a quick worsening, within 30 min, until the reach of a catatonic state, (iii) the Emax associate catatonic neurological state and anticholinergic signs, (iv) the duration of the catatonic Emax was 4.5 h, (v) the recovery phase was marked by the onset of agitation, delirium and hallucinations, (vi) and the duration of the anticholinergic syndrome was 6h. The total duration of intoxication was 7 h with a complete return to normal consciousness. Toxicological analysis performed in samples collected 3 h after exposure revealed scopolamine in blood at a concentration of 1.2 ng/mL and in urine at a concentration of 216 ng/mL. The other results of the pharmaco-toxicological screening remained without any toxicological interest.Discussion and conclusion. - This case highlights a new mode of incapacitation: inhaled scopolamine. Toxicological analysis confirmed the patient was only exposed to inhaled scopolamine, making toxicodynetics parameters valid. Even if scopolamine has only incapacitation effect, it is easy to imagine the list of extra-accidents that may result from any physical activity requiring a perfect coordination of gestures, coordination being completely but temporarily disturbed under the influence of inhaled scopolamine. The relatively short duration of poisoning makes the use of antidote useless. (C) 2019 Published by Elsevier Masson SAS on behalf of Societe Francaise de Toxicologie Analytique.