Acute benztropine intoxication and fatality.
A woman was found unresponsive with an empty bottle of Cogentin(®) prescribed to another. Admitted to an area hospital, her condition steadily declined until death 29 h after admission. Following toxicological screening on hospital (admission) whole blood, the only significant compound detected was benztropine. Benztropine was confirmed at 0.28 mg/L - the highest antemortem blood concentration recorded in a case of toxicity or fatality uniquely associated with benztropine. A second serum antemortem specimen showed a benztropine concentration of 0.19 mg/L. Despite over 24 h in the hospital, benztropine was also found in the postmortem specimens collected at autopsy. Peripheral blood, central blood, liver, and gastric concentrations were 0.47 mg/L, 0.36 mg/L, 9.6 mg/kg, and 44 mg, respectively. These results indicate that benztropine exhibited a potential difference between whole-blood and serum (plasma) concentrations. Additionally, in consideration of literature data, benztropine was found indicative of a compound prone to at least some postmortem redistribution.
County of San Diego Medical Examiner's Office, 5570 Overland Avenue, Suite 101, San Diego, CA, 92123.
Iain M
IM
McIntyre
Phyllis
P
Mallett
Christopher G
CG
Burton
Jacquelyn
J
Morhaime
D001590:Benztropine / Q000032:analysis / Q000506:poisoning*; D018680:Cholinergic Antagonists / Q000032:analysis / Q000506:poisoning*; D005260:Female; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D008099:Liver / Q000737:chemistry; D008875:Middle Aged; D013405:Suicide
D018680:Cholinergic Antagonists; D001590:Benztropine
antemortem and postmortem concentrations; benztropine; fatality; forensic science; postmortem redistribution