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Acute benztropine intoxication and fatality.

Iain M McIntyre1, Phyllis Mallett, Christopher G Burton

  • 1County of San Diego Medical Examiner's Office, 5570 Overland Avenue, Suite 101, San Diego, CA, 92123.

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Summary

A woman died after ingesting benztropine (Cogentin®), a medication not prescribed to her. Toxicological analysis revealed the highest recorded antemortem blood concentration of benztropine, indicating its toxicity.

Keywords:
antemortem and postmortem concentrationsbenztropinefatalityforensic sciencepostmortem redistribution

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Area of Science:

  • Forensic Toxicology
  • Clinical Toxicology
  • Pharmacology

Background:

  • Cogentin® (benztropine) is an anticholinergic medication used to treat Parkinsonism and drug-induced extrapyramidal symptoms.
  • Accidental or intentional overdose of benztropine can lead to severe toxicity and potentially fatal outcomes.

Observation:

  • A case study involving a woman found unresponsive with an empty bottle of benztropine prescribed to another individual.
  • The patient's condition deteriorated, leading to death 29 hours after hospital admission.

Findings:

  • Toxicological screening detected benztropine as the sole significant compound in the patient's blood upon admission.
  • The highest recorded antemortem blood concentration of benztropine (0.28 mg/L) was identified in this case.
  • Benztropine was also detected in postmortem specimens, suggesting potential postmortem redistribution and differences between whole blood and serum concentrations.

Implications:

  • This case highlights the critical importance of accurate medication reconciliation and the potential dangers of benztropine toxicity.
  • The findings underscore the need for comprehensive toxicological analysis in cases of unexplained unresponsiveness and death.
  • Understanding benztropine's pharmacokinetic behavior, including postmortem redistribution, is crucial for accurate interpretation of toxicological data in forensic investigations.