Near-fatal outcome after administration of hyoscine-N-butylbromide (Buscopan®)

Abstract

While undergoing conscious sedation for a gastroscopy, an 18-year-old female developed severe hypotension and loss of consciousness. This occurred shortly after an intravenous dose of hyoscine-N-butylbromide (Buscopan®). Resuscitation was performed over a period of 10 minutes and was successful. Once conscious, the patient complained of severe lower abdominal pain. Except for a significant metabolic acidosis (BE = -10), initial investigations were negative. She was transferred to the Intensive Care Unit (ICU) where the abdominal pain continued and the urine output was scanty for the first 12 hours. Investigations were done to exclude: anaphylaxis, mesenteric ischaemia, angioneurotic oedema, pregnancy, porphyria, autoimmune disease and myocardial ischaemia. Finally it was postulated that the drug had either caused an anaphylactoid reaction or grossly augmented cardiovagal nervous inhibition. This resulted in hypotension which caused mesenteric ischaemia that in turn resulted in severe abdominal pain and a degree of renal shutdown.

Keywords: anaphylaxis; angioneurotic oedema; hyoscine-N-butylbromide; porphyria