title: Scopolamine treatment for severe extra-pyramidal signs following organophosphate (chlorpyrifos) ingestion.
abstract: BACKGROUND
  The use of competitive inhibitors of acetylcholine other than atropine, for patients with organophosphate poisoning is controversial. Because scopolamine ability to cross the blood-brain barrier is better than that of atropine, it has been suggested that it should be used in patients with organophosphate poisoning who have central nervous system manifestations.
  
  
  METHODS
  A 17-year-old girl was admitted to the pediatric ward after ingesting chlorpyrifos as a suicidal attempt. She reported vomiting three times. She had no other symptoms for 12 hours and then over the course of 36 hours gradually developed extrapyramidal signs and became comatose. She was treated with intravenous scopolamine. Within 3 minutes the patient started to respond to verbal commands and answered simple questions rigidity subsided, and she was able to sit in bed. She was discharged after 4 days with no neurological sequelae.
  
  
  CONCLUSIONS
  We suggest, that in patients with organophosphate poisoning who have mainly central nervous system toxicity scopolamine administration might be considered.
authors.affiliation: Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Kventsel
authors.forename: Matitiahu
authors.initials: M
authors.lastname: Berkovitch
authors.forename: Ahuva
authors.initials: A
authors.lastname: Reiss
authors.forename: Mordechai
authors.initials: M
authors.lastname: Bulkowstein
authors.forename: Eran
authors.initials: E
authors.lastname: Kozer
mesh_terms: D000293:Adolescent; D004390:Chlorpyrifos / Q000506:poisoning*; D003128:Coma / Q000139:chemically induced / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D020734:Parkinsonian Disorders / Q000139:chemically induced / Q000188:drug therapy*; D011041:Poisoning / Q000188:drug therapy; D012601:Scopolamine / Q000627:therapeutic use*; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D007306:Insecticides; D018727:Muscarinic Antagonists; D012601:Scopolamine; D004390:Chlorpyrifos