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      Sumisión química en los Servicios de Urgencias de la Red Hospitalaria Translated title: Chemical submission in the Emergency Services of the Hospital Network

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          Abstract

          RESUMEN Antecedentes y objetivos: la escopolamina se emplea de forma subrepticia para cometer actos ilícitos. El número de casos de sospecha de consumo de esta sustancia en los servicios sanitarios de urgencias parece haber aumentado en los últimos años. No existe una clara y rigurosa relación con el número de casos descritos en la literatura científica, debido a la dificultad que supone su detección en los sujetos que se encuentran bajo sus efectos. Se plantea la profundización sobre la sumisión química, al describirse un caso clínico registrado en el Servicio de Urgencias del Hospital Central de la Defensa Gómez Ulla y una mejora del abordaje de este tipo de casos desde el triaje. Material y método: el estudio del caso registrado se ha basado en la descripción del método de detección analítico de la escopolamina y se ha apoyado en una revisión bibliográfica empleando distintas bases especializadas en referencia a intoxicación por escopolamina y su empleo en actos delictivos. Resultados: se identificó escopolamina. Al ser una sustancia cuya detección es tiempo-dependiente, el Hospital Central de la Defensa Gómez Ulla estableció un protocolo junto con el Instituto de Toxicología de la Defensa en 2018, a fin de realizar analíticas de identificación de sustancias empleadas en los casos de sospecha de sumisión química. Conclusiones: se plantea la necesidad de establecer protocolos de tipo multidisciplinar adecuados en los servicios de urgencias, estableciendo un diagnóstico diferencial en casos con alteraciones en el nivel de consciencia, al existir la posibilidad de intoxicación por escopolamina y sospecha de sumisión química, ya que la detección de la sustancia es tiempo-dependiente.

          Translated abstract

          SUMMARY Antecedents and objectives: Scopolamine is used to commit illegal acts. The number of suspected cases of this substance in the Emergency Services seems to have increased in recent years. There is no clear and rigorous relationship with the number of cases described in the scientific literature, due to the difficulty of its detection in subjects who are under its effects. A further study on Chemical Submission is proposed, by describing a clinical case registered in the Emergency Service of the Gómez Ulla Central Defense Hospital and an improvement in the approach to this type of cases from triage. Material and methods: The study of the registered case has been based on the description of the analytical method and supported by a bibliographic review using different specialized bases in reference to Escopolamine poisoning and its use in criminal acts. Results: Being a substance whose detection is time-dependent, the Gómez Ulla Central Defense Hospital established a protocol together with the Defense Toxicology Institute in 2018 in order to carry out identification analyzes of substances used in cases of Suspected Submission Chemistry. Conclusions: The need to establish appropriate multidisciplinary protocols in the Emergency Services arises. Propose a differential diagnosis in cases with alterations in the level of consciousness, as there is the possibility of scopolamine intoxication and suspicion of Chemical Submission, since the detection of the substance is time-dependent.

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          Most cited references21

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          Anticholinergic syndrome following an unintentional overdose of scopolamine

          Scopolamine hydrobromide (hyoscine) is an antimuscarinic drug which is primarily used in the prophylaxis and treatment of motion sickness and as a premedication to dry bronchial and salivary secretions. In acute overdosage, the main clinical problem is central nervous system (CNS) depression. In Australia, tablets containing scopolamine hydrobromide 0.3 mg are available over the counter in packs of ten. The recommended dose for adults is one to two tablets as a single dose, repeated four to six hours later, if required. The maximum dose stated on the pack is four tablets over a 24-hour period with a caution regarding drowsiness and blurred vision. We describe a patient who presented with symptoms of anticholinergic syndrome secondary to an unintentional overdose of scopolamine. Whilst at work, the patient noticed that he had forgotten his prescribed medication, domperidone, at home; a friend gave him some travel sickness medication which contained scopolamine for relief of nausea. On a previous occasion, he had experienced a similar, less severe reaction with another anticholinergic agent, loperamide. This report highlights the need to consider nonprescription products, ie, over the counter medications, herbal/nutritional supplements as causes of anticholinergic syndrome when a patient presents with symptoms suggestive of this diagnosis.
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            Scopolamine impairs human recognition memory: data and modeling

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              • Article: not found

              Scopolamine as an antidepressant: a systematic review

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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                March 2023
                : 79
                : 1
                : 18-21
                Affiliations
                [1] Madrid orgnameHospital Central de la Defensa Gómez Ulla orgdiv1Servicio de Anestesiología y Reanimación España
                [3] Madrid orgnameHospital Central de la Defensa Gómez Ulla orgdiv1Servicio de Urgencias España
                [4] Madrid orgnameEscuela Militar de Sanidad orgdiv1Academia Central de la Defensa España
                [6] Madrid orgnameHospital Central de la Defensa Gómez Ulla orgdiv1Instituto de Toxicología de la Defensa orgdiv2Área de Cromatografía España
                [5] Madrid orgnameEscuela Militar de Sanidad orgdiv1Academia Central de la Defensa España
                [2] Madrid orgnameHospital Central de la Defensa Gómez Ulla orgdiv1Instituto de Toxicología de la Defensa España
                Article
                S1887-85712023000100004 S1887-8571(23)07900100004
                10.4321/s1887-85712023000100004
                dd7043d6-0fbb-4fe8-be90-70a73d2b7a3e

                http://creativecommons.org/licenses/by/4.0/

                History
                : 31 July 2021
                : 25 November 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 4
                Product

                SciELO Spain

                Categories
                Artículo Original

                Escopolamina,Intoxicación,Sumisión química,Scopolamine,Intoxication,Chemical submission

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