ABSTRACT
Background: Olanzapine is an atypical antipsychotic widely prescribed in schizophrenia patients because of its better tolerability. Clinical picture due to olanzapine over dosage can be confusing in the emergency department. Also often the patient would be drowsy to provide adequate information regarding the method of self harm attempt. Case description: We are reporting a case of olanzapine over dosage which presented to the emergency department with pin point pupils, lacrimation, and hypotension and semi conscious state. Discussion: Organophosphorous poison consumption is one of the common methods of suicide in rural south Indian setting which presents with miosis, respiratory depression and unconsciousness. Pontine hemorrhage is one more condition apart from opiod intoxication which presents with pin point pupils and altered mental status. Conclusion: We attributed olanzapine over dosage as the cause of pin point pupils, lacrimation and drowsiness in our case as other causes were excluded.