{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:18:43Z","timestamp":1785406723549,"version":"3.56.0"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["BG-RRP-2.004-0009-C02"],"award-info":[{"award-number":["BG-RRP-2.004-0009-C02"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"award":["BG-RRP-2.004-0009-C02"],"award-info":[{"award-number":["BG-RRP-2.004-0009-C02"]}],"id":[{"id":"https:\/\/ror.org\/019w4f821","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoX"],"abstract":"<jats:p>Introduction: Scopolamine is a tropane alkaloid and non-selective muscarinic receptor antagonist capable of inducing a central anticholinergic toxidrome with pronounced neuropsychiatric and autonomic manifestations. Despite its well-characterized pharmacology, diagnosis remains clinically challenging due to variable presentation and often absent or unreliable exposure history, particularly in non-medical contexts. Methods: We report a case of a 34-year-old female presenting with an acute onset of altered mental status following a social event. Clinical findings included delirium, hallucinations, psychomotor agitation, dysarthria, bilateral mydriasis with preserved light reflex, sinus tachycardia, and marked urinary retention. Routine laboratory investigations were largely within normal limits, and standard urine toxicology screening was negative except for iatrogenic benzodiazepines. Given the characteristic toxidrome, extended toxicological analysis using gas chromatography\u2013mass spectrometry (GC\u2013MS) was performed, confirming the presence of scopolamine. Supportive treatment, including benzodiazepines and off-label intravenous galantamine, was administered, resulting in progressive clinical improvement and complete recovery without sequelae. Results: This case underscores the diagnostic limitations of routine toxicology screening for tropane alkaloids and highlights the importance of a pattern-based toxidrome approach. Given the absence of reliable exposure history and the presence of marked anterograde amnesia, an exogenous exposure cannot be excluded; however, no direct forensic evidence supports intentional administration. Furthermore, galantamine may represent a pharmacologically plausible alternative to physostigmine in settings where it is unavailable, although evidence remains limited. Conclusions: Scopolamine intoxication should be considered in cases of acute anticholinergic syndrome with negative standard screening, and confirmation requires advanced analytical methods such as GC\u2013MS.<\/jats:p>","DOI":"10.3390\/jox16030097","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:37:29Z","timestamp":1780544249000},"page":"97","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Anticholinergic Toxic Syndrome Due to Scopolamine Exposure: A Case Report with Possible Drug-Facilitated Administration"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0528-0289","authenticated-orcid":false,"given":"Stanila","family":"Stoeva-Grigorova","sequence":"first","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1911-4755","authenticated-orcid":false,"given":"Ivanesa","family":"Yarabanova","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Department, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5778-4043","authenticated-orcid":false,"given":"Maya","family":"Radeva-Ilieva","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Galina","family":"Uzunova","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Toxicology, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6220-4020","authenticated-orcid":false,"given":"Georgi","family":"Bonchev","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Toxicology, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivanka","family":"Gospodinova","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Toxicology, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violeta","family":"Borisova","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Toxicology, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmira","family":"Vicheva","sequence":"additional","affiliation":[{"name":"Laboratory of Analytical Toxicology, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9573-0593","authenticated-orcid":false,"given":"Simeon","family":"Marinov","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Medical University of Varna, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petko","family":"Marinov","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Clinical Toxicology Department, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snezha","family":"Zlateva","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Toxicology and Pharmacotherapy, Faculty of Pharmacy, Medical University of Varna, 9000 Varna, Bulgaria"},{"name":"Clinical Toxicology Department, Naval Hospital, 9000 Varna, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","first-page":"21","article-title":"Plant toxins: Alkaloids and their toxicities","volume":"6","author":"Adibah","year":"2019","journal-title":"GSC Biol. 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