Section of Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
Unit of Forensic Pathology, SAIMLAL Department, Sapienza University of Rome, Rome, Italy.
Int J Legal Med. 2021 Jul;135(4):1455-1460. doi: 10.1007/s00414-021-02583-2. Epub 2021 Apr 23.
Scopolamine is an alkaloid which acts as competitive antagonists to acetylcholine at central and peripheral muscarinic receptors. We report the case of a 41-year-old male convict with a 27-year history of cannabis abuse who suddenly died in the bed of his cell after having smoked buscopan® tablets. Since both abuse of substances and recent physical assaults had been reported, we opted for a comprehensive approach (post-mortem computed tomography CT (PMCT), full forensic autopsy, and toxicology testing) to determine which was the cause of the death. Virtopsy found significant cerebral edema and lungs edema that were confirmed at the autopsy and at the histopathological examination. Scopolamine was detected in peripheral blood at the toxic concentration of 14 ng/mL in blood and at 263 ng/mL in urine, and scopolamine butyl bromide at 17 ng/mL in blood and 90 ng/mL in urine. Quetiapine, mirtazapine, lorazepam, diazepam, and metabolites and valproate were also detected (at therapeutic concentrations). Inmates, especially when they have a history of drug abuse, are at risk to use any substance they can find for recreational purposes. In prisons, active surveillance on the management and assumption of prescribed drugs could avoid fatal acute intoxication.
莨菪碱是一种生物碱，作为竞争性拮抗剂，在中枢和外周毒蕈碱受体作用于乙酰胆碱。我们报告了一个 41 岁的男性罪犯的案例，他有 27 年的大麻滥用史，在吸食了布斯可潘®片后突然死在牢房的床上。由于有药物滥用和最近身体攻击的报告，我们选择了综合方法（尸检后计算机断层扫描（PMCT）、全面法医解剖和毒物学检测）来确定死亡的原因。虚拟尸检发现了显著的脑水肿和肺水肿，在尸检和组织病理学检查中得到了证实。莨菪碱在血液中的浓度为 14ng/ml（血液）和 263ng/ml（尿液），在血液中的浓度为 17ng/ml（尿液）和 90ng/ml（尿液）。还检测到了莨菪碱丁基溴化物（血液）和 90ng/ml（尿液）。在血液和尿液中还检测到了喹硫平、米氮平、劳拉西泮、地西泮及其代谢物和丙戊酸（治疗浓度）。囚犯，尤其是有药物滥用史的囚犯，他们有风险会使用任何他们可以找到的物质进行娱乐。在监狱中，对管理和服用规定药物进行积极监测可以避免致命的急性中毒。
