Finding into death of David Scrofano

41y · Male·Pheniramine toxicity

David Scrofano, 41, died from pheniramine toxicity following an overdose of antihistamine tablets. He had a long history of schizophrenia, acquired brain injury, and poly-substance abuse. When found by police behaving erratically, his presentation—agitation, disorientation, unsteady gait—was incorrectly attributed to mental illness rather than drug toxicity. Clinical lessons include: the diagnostic difficulty in distinguishing drug toxicity from psychiatric illness or intoxication in acute presentations; the importance of comprehensive medication history and substance abuse screening in patients with psychiatric disorders; the risks posed by unsupervised access to over-the-counter antihistamines in vulnerable populations; and the challenges for emergency responders in recognizing antihistamine overdose, which mimics acute psychiatric decompensation. Pheniramine's anticholinergic effects (dry mucous membranes, agitation, seizures) were not recognized by paramedics or police. Earlier recognition and supportive treatment might have altered outcome, though evidence does not definitively establish preventability.