Case presentation
A 9-year-old female was presented to the emergency room of our hospital with complaints of exhibiting abnormal behaviors. The symptoms had developed over the previous six hours. She complained of being dizzy and experiencing a dry mouth. Intermittent hallucinations started. She described her visions of “her friends playing games.” She heard “her mother’s voice calling her.” She also had a tactile hallucination in which she felt something crawling on her back. She constantly attempted to pick imaginary things from the floor.
Upon arrival at the emergency, the girl was hyperactive and was held still by her uncle. She had a blood pressure of 110/70 mm of Hg, a heart rate of 92 /min, a temperature of 98.2 F, respiratory rate of 20 /min. Her mouth and skin were dry. Pupils were slightly dilated and reactive to light. She was constantly agitated and restless. Her cognitive deficits were quite remarkable because she was unable to recognize previously familiar people and was not oriented to place or time. There were no focal neurological abnormalities found. There was no history of head trauma, and no obvious injuries were discovered. A day prior, the girl had visited OPD for complaints of abdominal pain for which hyoscine butylbromide 20 mg was prescribed to be taken three times a day.
Laboratory results for hemoglobin, total leukocyte count, platelet count, urine routine and microscopy, liver function test, renal function test, and random blood sugar were within normal limits. The chest X-ray was normal. Due to her bizarre behavior and suspicion of hyoscine intoxication, she was admitted for further evaluation. A pediatrician and a psychiatrist were consulted. The prescription of hyoscine was stopped.
The evening after admission, the girl showed improvement in her symptoms including her memory and hallucinations. She was no longer hyperactive and began to become shy. After proper counseling to her relatives, she was discharged. On follow-up, there was no recurrence of those symptoms and she was completely recovered.