Scopolamine intoxications

Pure scopolamine intoxications are extremely rare. We treated a series of severe intoxications exclusively caused by scopolamine and due to the intentional mixing of pure scopolamine into drinks. The clinical course and therapy are reported. On the basis of our experience and a survey of literature, we found physostigmine to be an excellent antidote. The symptomatology of the patients confirms that scopolamine has a dose-related stimulant effect on the central nervous system.     

Maximum expiratory flow rates in induced bronchoconstriction in man

We evaluated changes of maximum expiratory flow-volume (MEFV) curves and of partial expiratory flow-volume (PEFV) curves caused by bronchoconstrictor drugs and dust, and compared these to the reverse changes induced by a bronchodilator drug in previously bronchoconstricted subjects. Measurements of maximum flow at constant lung inflation (i.e. liters thoracic gas volume) showed larger changes, both after constriction and after dilation, than measurements of peak expiratory flow rate, 1 sec forced expiratory volume and the slope of the effort-independent portion of MEFV curves. Changes of flow rates on PEFV curves (made after inspiration to mid-vital capacity) were usually larger than those of flow rates on MEFV curves (made after inspiration to total lung capacity). The decreased maximum flow rates after constrictor agents are not caused by changes in lung static recoil force and are attributed to narrowing of small airways, i.e., airways which are uncompressed during forced expirations. Changes of maximum expiratory flow rates at constant lung inflation (e.g. 60% of the control total lung capacity) provide an objective and sensitive measurement of changes in airway caliber which remains valid if total lung capacity is altered during treatment.     

Scopolamine withdrawal syndrome

As travel by air and ship becomes increasingly popular, more and more travelers are using transdermal scopolamine to avoid motion sickness. In fact, it has become almost fashionable for ocean travelers to sit on the sun deck with a patch behind the ear. This article describes withdrawal symptoms in a patient who used transdermal scopolamine beyond the recommended 3 days.     

Scopolamine effects in vestibular defensiveness

Disturbed vestibular function secondary to brain stem injury may result in postural gravitational insecurity, and aversion reactions or intolerance to movement. The Transderm scopolamine disc was applied in a double-blind, placebo-controlled study of five post-head-injury patients who underwent provocative vestibular stimulation such as turning in a wheelchair, head shaking, and the log roll. Four of the patients showed improvement in exquisite sensitivity to rotational movement. A surprise finding of improved truncal stability in two of the more severely injured patients indicates a potential usefulness of the scopolamine patch for patients with truncal ataxia.     

Metabolic clearance and production rates of prolactin in man.

Metabolic clearance rates (MCR) and production rates (PR) of prolactin (PRL) have been determined by the constant infusion to equilibrium technique in 11 normal subjects, 6 patients with hyperthyroidism, 4 patients with hypothyroidism, and 9 patients with hyperprolactinemia. PRL MCR was also determined tin four patients during dopamine infusion. Mean PRL MCR was 46 +/- 1 ml/min per m2 in women and 44 +/- 3 ml/min per m2 in men, and was significantly correlated with body mass (r = 0.84, P less than 0.001). In contrast with controls, PRL MCR was higher in hyperthyroidism (MCR = 52 +/- 8 ml/min per m2, P less than 0.05), was slightly lower in hypothyroidism (MCR = 38 +/- 10 ml/min per m2, P = NS), and was significantly correlated with serum thyroxine (r = 0.46, P less than 0.02). PRL MCR was lower than controls in hyperprolactinemia (MCR = 40 +/- 5 ml/min per m2, P less than 0.01) and was inversely correlated with serum PRL (r = -0.72, P less than 0.001). PRL MCR was not significantly changed by dopamine infusion. Mean PRL PR for women and men was 211 +/- 74 and 187 +/- 44 micrograms/d per m2, respectively (P = NS). In hyperthyroidism the PRL PR was elevated (PR = 335 +/- 68 micrograms/d per m2, P less than 0.02), but in hypothyroidism the increase (PR = 233 +/- 159 micrograms/d per m2) was not significant. In hyperprolactinemia the PRL PR was extremely high (PR = 31,000 +/- 29,000 micrograms/d per m2). Dopamine infusion decreased RPL PR from 270 to 66 micrograms/d per m2 indicating that its effect was on pituitary PRL secretion and not PRL metabolism. To evaluate possible circulating PRL heterogeneity that might arise during infusion, gel filtration of infusate and serum obtained during the MCR procedure was performed. Labeled monomeric PRL (peak III, Kav (partition coefficient) = 0.4) was partially converted to two larger forms (peaks I and II) in vivo. Peak I (Kav = 0) was 30--40% immunoprecipitable, although peak II (Kav = 0.2) was not immunoprecipitable. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of peak I resulted in greater than or equal to 90% conversion to peak III and restoration of full immunoactivity. Thus, peak I is a noncovalently linked aggregate that is partially immunoactive, and therefore able to alter MCR determinations. These studies demonstrate the impact of hormone heterogeneity on MCR estimations and suggest that gel filtration of immunoprecipitable material be an integral part of future MCR measurements.     

东莨菪碱治疗氨基甲酸酯类农药中毒的疗效观察

氨基甲酸酯类农药中毒 79例 ,实验组 5 7例给予东莨菪碱治疗 ,对照组 2 2例给予阿托品治疗 ,结果东莨菪碱组比阿托品组中毒症状消失快 ,胆碱酯酶活力恢复快 ,不良反应少 ,治愈时间短 (P <0 .0 1)。     

东茛菪碱让旅途更加轻松

有人说，旅途的过程往往比目的地本身更令人享受。但如果您患有晕动症，或同车同船的其他人患有晕动症，事实就绝非如此了。近期更新的一篇Cochrane系统评价显示，东莨菪碱可有效预防这类问题。     

东莨菪碱让旅途更加轻松

有人说,旅途的过程往往比目的地本身更令人享受。但如果您患有晕动症,或同车同船的其他人患有晕动症,事实就绝非如此了。近期更新的一篇Cochrane系统评价显示,东莨菪碱可有效预防这类问题。     

Scopolamine bioavailability in combined oral and transdermal delivery

Transdermal therapeutic system scopolamine (TTS-S) is effective in preventing motion sickness for 72 h. However, by this route a prophylactic effect is obtained 6 to 8 h postapplication. By the oral route, scopolamine is effective within 0.5 h for a period of 6 h. To achieve safe as well as effective protection against seasickness during the first hours of a voyage until the TTS-S patch takes effect, the pharmacokinetics of scopolamine was investigated after patch application in combination with oral tablets, 0.6 mg, 0. 3 mg, or placebo. Subjects were 25 naval-crew volunteers, randomly divided into three groups: group 1 (n = 9), TTS-S patch + 0.6 mg of scopolamine per os (p.o.); group 2 (n = 8), TTS-S patch + 0.3 mg of scopolamine p.o.; and group 3 (n = 8), TTS-S patch + placebo tablet. Blood samples were collected before treatment and 0.5, 1, 1.5, 2.5, 3.5, 6, 8, and 22 h post-treatment, and were analyzed for scopolamine levels using radioreceptor assay. Significantly higher plasma scopolamine levels were found in group 1 at 0.5, 1, 1.5, and 2.5 h, and in group 2 at 1 and 1.5 h post-treatment, compared with group 3. Thereafter, plasma levels did not differ significantly between the groups. In all subjects of group 1 and seven subjects (88%) of group 2, therapeutic levels (>50 pg/ml) were measured during the first 2.5 h, compared with only two subjects (25%) of group 3 (P < 0.05). Heart rate, blood pressure, visual accommodation, performance test results, and subjective complaints of adverse effects did not differ significantly. The combination of transdermal and oral scopolamine (0.3 or 0.6 mg) provides the required plasma levels to prevent seasickness, starting as early as 0.5 h post-treatment, with no significant adverse effects.     

Simultaneous antepartum testing of twin fetal heart rates

Assessment of twin gestation in the antepartum period has been a problem because most methods either fail to distinguish twins individually or require serial study over several weeks before reaching diagnostic end points. Electronic monitoring of the fetal heart rate (FHR) allows individual focus on each twin with a high degree of specificity and permits immediate status evaluation. In this study 44 sets of twins had simultaneous Doppler monitoring in an outpatient testing center. Transducer position was aided by real-time ultrasonic location of each fetal heart; 198 tests were satisfactory, each patient receiving 3.9 +/- 2.9 (mean +/- SD) studies. The rate of unsatisfactory tests was 15.4%, though each fetus was satisfactorily tested within one week of delivery. Testing was begun at 32.9 +/- 2.9 weeks and delivery occurred at 36.8 +/- 2.6 weeks. Perinatal mortality was 22.7/1,000, significant morbidity 15.9%, and cesarean section rate 18.1%. Reactive (R) patterns were seen in 69 fetuses and nonreactive (NR) in 19. Although there were no significant differences in gestational age at delivery between R and NR groups, (36.9 vs 36.2 wk) NR fetuses had significantly lower birth weights and higher rates of neonatal depression, perinatal mortality, and retarded intrauterine growth. Similarities in FHR patterns within twin pairs were frequently observed (30/44). Twins exhibiting dissimilar patterns had significant differences in birth weight and tended to have separate rather than common placentas. Simultaneous FHR testing of twins appears to be an effective means of providing immediately accessible data on the comparative well-being of each twin.     

Determination of glucose turnover and glucose oxidation rates in man with stable isotope tracers

Determination of the turnover rates of glucose gives a more dynamic view of carbohydrate metabolism. Using 2H- or 13C-labelled glucose, stable isotope methods have been established which are free of risk for volunteers or patients and are in accordance with the legal requirements for radiation protection. The aim of the present study was to determine the main parameters of glucose turnover in vivo by using two stable-isotope-labelled glucose molecules, [6,6-2H]glucose and [U-13C]glucose. Under steady state conditions, the following parameters were analysed: glucose turnover rate, glucose oxidation rate, recycling of glucose, hepatic glucose production rate, and glucose clearance. In healthy volunteers the following data were obtained for the glucose turnover rate: 2.42 +/- 0.11 mg/kg x min, glucose oxidation rate 1.34 +/- 0.08 mg/kg x min, glucose clearance 3.04 +/- 0.17 ml/kg x min, and glucose recycling 24.7% (about 0.6 mg/kg x min). Under conditions of the euglycaemic-hyperinsulinaemic clamp (insulin levels about 80 mU/l) the glucose turnover rate increased to 9-10 mg/kg x min, and the hepatic glucose production rate was totally suppressed. Under these conditions identical glucose turnover rates were measured by rate of appearance Ra and euglycaemic-hyperinsulinaemic clamp. These data clearly demonstrate that by using differentially labelled glucose molecules at least five parameters of glucose metabolism may be determined in vivo. High insulin levels (70-80 mU/l) stimulate glucose turnover rate by 300-400%, and the glucose infusion rate agrees well with the rate of appearance (Ra) of glucose, determined with [6,6-2H]glucose. Thus, this glucose tracer provides relevant and presumably accurate data under basal and under hyperinsulinaemic conditions.     

A Nonfatal Case of Intentional Scopolamine Poisoning

Abstract

The Toxicology Service at the Medical University of Southern Africa (MEDUNSA) deals with a predominantly developing Black patient population. To determine priorities, a retrospective comparative epidemiological study for the period 1970–1976 was made of Black and White patients admitted to the teaching hospitals of the University of the Orange Free State. The study revealed that among Whites the pattern of poisoning was very similar to that reported from developed countries. Drug poisonings predominated, there were more deliberate than accidental poisonings, and the majority of patients were females. Among the developing Black community, the picture differed markedly. Drug overdoses were responsible for very few poisonings, most poisonings were accidental, and males predominated. In addition, the vast majority of poisonings occurred in childhood. Accordingly, the toxicology service at MEDUNSA regards drug identification and psychiatric help for attempted suicides as low priorities and is geared toward establishing epidemiological trends and dealing with problems such as the treatment and prevention of organo-phosphate poisoning, paraffin poisoning, carbon monoxide poisoning, and poisoning with traditional African medicines.