<div><i>Email:Nimesh.lageju@yahoo.com</i></div><div>ORCID iD</div><div>https://orcid.org/0000-0002-1411-5867</div><div>Lokesh Shekher Jaiswal</div><div>Email:
lokesh­_shekher@yahoo.com</div><div>ORCID ID</div><div>https://orcid.org/0000-0002-0813-8747</div><div>Corresponding author</div><div>Durga Neupane</div><div>Email:
neupanedurga26@gmail.com</div><div>ORCID iD</div><div>https://orcid.org/0000-0002-9736-9335</div><div><b>Word count:</b> 512</div><div><b>Running title:</b> Hyoscine induced psychosis</div><div><b>Keywords:</b> hyoscine butylbromide; psychosis; children; abdominal
pain; side effect</div><div>Abdominal pain is reported by a third of school-aged children
(Saps M, Seshadri R, et al. 2009).  Although the use of analgesia to
treat acute abdominal pain is well-supported (Falch C, Vicente D, et
al. 2014), there is little evidence to lead the management of
nonspecific abdominal pain in the emergency department, which accounts
for two-thirds of cases of abdominal pain presenting to the emergency
department. In the pediatric study, hyoscine butylbromide, 10 mg given
orally, was found to be beneficial compared to a homeopathic preparation
with no serious adverse effects (Müller-Krampe B, Oberbaum M, et
al. 2007).</div><div>A 9-year-old female child was brought to the OPD with a history of
non-specific colicky abdominal pain. The attending physician assessed
and prescribed her 20 mg hyoscine butylbromide to be taken three times a
day for three days. The patient went home and took her first dose during
the noon and the other before going to bed. Suddenly, at midnight, she
woke up and started to show unusual behaviour. She screamed and told
that something was crawling over her back, suggestive of tactile
hallucination. She experienced visual and auditory hallucinations as
explained by her parents. Then, she was rushed to the emergency
department at the same hospital and was clinically assessed. The on-duty
doctor found to have features of acute psychosis in her and was referred
to psychiatrist.</div><div>A diagnosis of drug induced psychosis was established. She was asked to
withdraw the drug and her psychotic features gradually disappeared and
was back to her usual state of health after few days.</div><div>Bulut et al presented a young female patient who progressively developed
a series of complex neuropsychiatric symptoms including ataxia, slurred
and rambling speech, stereotypic movements, vivid visual and auditory
hallucinations, and self-mutilative behaviours in the days following the
injection of hyoscine butylbromide in the emergency room to treat her
menstrual cramps. A diagnosis of acute psychosis was established and was
started on olanzapine. After few weeks, her condition was resolved
(Bulut NS, Arpacıoğlu ZB. 2020).</div><div>Poonai et al randomly assigned children aged 8–17 years with
nonspecific colicky abdominal pain who presented to the pediatric
emergency department of London Health Sciences Centre, London, Ontario
to receive hyoscine butylbromide, 10 mg given orally, or acetaminophen,
15 mg/kg given orally (maximum 975 mg) (Poonai N, Kumar K, et al. 2020).
Hyoscine butylbromide was not superior to acetaminophen in this setting.
Adverse effects in the emergency department were reported by 32/116
(27.6%) participants in the hyoscine butylbromide group. Common side
effects were nausea, vomiting, dizziness, and photosensitivity. There
were no serious adverse effects (Poonai N, Kumar K, et al. 2020).</div><div>Only few studies have shown the safety and efficacy of hyoscine
butylbromide in alleviating abdominal pain in children without any
severe adverse effect like acute psychosis being reported. The
aforementioned case was a rare side effect of the drug. With this
correspondence, we would like to reflect a message that hyoscine
butylbromide should be used carefully in children, along with the
emphasis on correct dose, frequency and experience of the practicing
clinician.</div><div><b>Conflict of interests:</b> None</div>