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 signi cant 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 rst 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.
