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Drevin G, Malbranque S, Jousset N, Férec S, Zabet D, Baudriller A, Briet M, Abbara C. Pharmacobezoar-Related Fatalities: A Case Report and a Review of the Literature. Ther Drug Monit 2024; 46:1-5. [PMID: 37941108 DOI: 10.1097/ftd.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/15/2023] [Indexed: 11/10/2023]
Abstract
ABSTRACT Pharmacobezoars develop after an acute overdose or during routine drug administration. Here, the authors present a case of fatal multidrug overdose involving a 62-year-old woman. Her usual treatment included tramadol extended-release, citalopram, and mirtazapine. Furthermore, she self-medicated and misused her husband's medications. The autopsy revealed the presence of a voluminous medication bezoar in the stomach. No mechanical complication was noted. Toxicologic analyses were performed using gas chromatography with flame ionization detection, liquid chromatography with diode array detection, gas chromatography with mass spectrometry detection, and liquid chromatography coupled to tandem mass spectrometry. Tramadol (34,000 mcg/L), O-desmethyltramadol (2200 mcg/L), propranolol (6000 mcg/L), bromazepam (2500 mcg/L), zopiclone (1200 mcg/L), and citalopram (700 mcg/L) were identified in femoral blood at toxic concentrations. Interestingly, the femoral blood and vitreous humor concentration ratio was approximately 0.7. Furthermore, an English exhaustive literature search was performed using several different electronic databases without any limiting period to identify published pharmacobezoar-related fatalities. Seventeen publications were identified reporting a total of 19 cases. Decedents' mean age was 47.6 years [0.8-79] and a clear female predominance emerged. Several drugs were involved in pharmacobezoar formation. Death was attributed to drug toxicity in 13 cases, and to mechanical complications and/or sepsis in 4 cases. A mixed cause of death was reported in 2 cases. Although rare, pharmacobezoars remain potentially lethal and raise challenges in therapeutic management.
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Affiliation(s)
- Guillaume Drevin
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire, Angers, France
- Université d'Angers, Angers, France
| | - Stéphane Malbranque
- Institut de Médecine légale, Centre Hospitalo-Universitaire, Angers, France; and
| | - Nathalie Jousset
- Université d'Angers, Angers, France
- Institut de Médecine légale, Centre Hospitalo-Universitaire, Angers, France; and
| | - Séverine Férec
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire, Angers, France
| | - Donca Zabet
- Institut de Médecine légale, Centre Hospitalo-Universitaire, Angers, France; and
| | - Antoine Baudriller
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire, Angers, France
| | - Marie Briet
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire, Angers, France
- Université d'Angers, Angers, France
- Laboratoire MitoVasc, UMR CNRS 6214 INSERM 1083, Angers, France
| | - Chadi Abbara
- Service de Pharmacologie-Toxicologie et Pharmacovigilance, Centre Hospitalo-Universitaire, Angers, France
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Burgos-Torres MDM, Molina-Lopez VH, Perez Cruz NM, Perez Del Valle C, Sorrentino J. Multivitamin-Induced Pharmacobezoar: A Rare Entity of Large Bowel Obstruction. Cureus 2023; 15:e41688. [PMID: 37441102 PMCID: PMC10334454 DOI: 10.7759/cureus.41688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 07/15/2023] Open
Abstract
The term bezoar refers to a foreign object found like a mass of concretion in the gastrointestinal tract that results from an accumulation of undigested material. When the composition of the ingested material is a medication, it is known as a pharmacobezoar. A rare complication from pharmacobezoar is large intestinal obstruction. Here we present the case of a 77-year-old male who presented with progressive abdominal distension, involuntary guarding, and large bowel obstruction. Abdominal imaging studies were remarkable for radiopaque objects of uncertain etiology in the transverse colon and rectal ampulla. The patient underwent colonic decompression by sigmoidoscopy, where the pills were identified by direct visualization. He later underwent endoscopic removal of the pharmacobezoars. A detailed medication review identified the culprit to be multivitamins. This case portrays an unusual etiology of large bowel obstruction. At this moment, no cases have been reported of multivitamins as the culprit of pharmacobezoar with subsequent development of large bowel obstruction.
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Affiliation(s)
| | | | | | | | - Jose Sorrentino
- General Surgery, VA Caribbean Helathcare System, San Juan, PRI
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Gierke H, Pfrommer T, Schäfer K, Weitschies W, Nolte T. Pharmacobezoar Formation From HPMC-AS-Containing Spray-Dried Formulations in Nonclinical Safety Studies in Rats. Toxicol Pathol 2022; 50:920-929. [PMID: 36541591 DOI: 10.1177/01926233221145112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Changing the physical state from crystalline to amorphous is an elegant method to increase the bioavailability of poorly soluble new chemical entity (NCE) drug candidates. Subsequently, we report findings from repeat-dose toxicity studies of an NCE formulated as a spray-dried amorphous solid dispersion (SD-ASD) based on hydroxypropyl methylcellulose acetate succinate (HPMC-AS) in rats. At necropsy, agglomerates of SD-ASD were found in the stomach and small intestine, which in reference to literature were termed pharmacobezoars. We interpreted the pH-dependent insolubility of HPMC-AS in the acidic gastric environment to be a precondition for pharmacobezoar formation. Gastric pharmacobezoars were not associated with clinical signs or alterations of clinical pathology parameters. Pharmacobezoar-correlated histopathological findings were limited to the stomach and consisted of atrophy, erosion, ulcer, and inflammation, predominantly of the nonglandular mucosa. Pharmacobezoars in the small intestines induced obstructive ileus with overt clinical signs which required unscheduled euthanasia, prominent alterations of clinical pathology parameters indicative of hypotonic dehydration, degenerative and inflammatory processes in the gastrointestinal tract, and secondary renal findings. The incidence of pharmacobezoars increased with dose and duration of dosing. Besides the relevance of pharmacobezoars to animal welfare, they limit the non-observed adverse effect level in nonclinical testing programs and conclusively their informative value.
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Affiliation(s)
| | - Teresa Pfrommer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Kerstin Schäfer
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Thomas Nolte
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
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Aydin I, Sengul I, Sengul D. Phytobezoar: An Unusual Condition Leading to Small Bowel Obstruction. Cureus 2022; 14:e23885. [PMID: 35402121 PMCID: PMC8985846 DOI: 10.7759/cureus.23885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
Bezoar is described as a swallowed, extraneous, and indigestible mass located in the gastrointestinal system; it accounts for 0.4-4.0% of all cases of mechanical intestinal obstruction. Intestinal obstruction is the most frequent complication of bezoar formation. Apart from intestinal obstructions, bezoars may also exhibit clinical symptoms such as abdominal pain, nausea, vomiting, weight loss, upper gastrointestinal bleeding, and gastric perforation. However, a considerable number of cases tend to be asymptomatic. Of note, its clinical symptoms cannot be differentiated easily from intestinal obstructions caused by other factors. As such, preoperative CT examination can provide invaluable information about the level of obstruction, etiology, and the existence of additional pathology and thereby help plan the type of surgical procedure required. If prompt diagnosis and timely treatment are not carried out, the condition may lead to significant morbidity and mortality.
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Affiliation(s)
- Ismail Aydin
- General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ilker Sengul
- Endocrine Surgery-General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| | - Demet Sengul
- Pathology, Giresun University Faculty of Medicine, Giresun, TUR
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5
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Serra S, Geniere Nigra S. Endoscopic removal of slow release oxycodone tablets in a case of voluntary acute poisoning. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We describe a case of 83-years-old women admitted to the Emergency Department after massive ingestion of slow release Oxycodone pills for suicidal purpose. After gastric lavage only few tablets has been retrieved and Naloxone infusion was necessary. After 2 hours from drug ingestion Esophagogastroduodenoscopy (EGDS) was performed and a number of tablets have been removed. Intoxication symptoms completely resolved and Naloxone infusion has been stopped. The clinical courses of this intoxication suggest that the utility of EGDS to remove tablets should be considered in selected cases of drug poisoning.
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6
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Basílio F, Dinis-Oliveira RJ. Clinical and Forensic Aspects of Pharmacobezoars. Curr Drug Res Rev 2020; 12:118-130. [PMID: 32065097 DOI: 10.2174/2589977512666200217094018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pharmacobezoars are specific types of bezoars formed when medicines, such as tablets, suspensions, and/or drug delivery systems, aggregate and may cause death by occluding airways with tenacious material or by eluting drugs resulting in toxic or lethal blood concentrations. OBJECTIVE This work aims to fully review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and other relevant clinical and forensic features of pharmacobezoars. RESULTS Patients of a wide range of ages and of both sexes present with signs and symptoms of intoxications or more commonly gastrointestinal obstructions. The exact mechanisms of pharmacobezoar formation are unknown but are likely multifactorial. The diagnosis and treatment depend on the gastrointestinal segment affected and should be personalized to the medication and the underlying factor. A good and complete history, physical examination, image tests, upper endoscopy, and surgery through laparotomy of the lower tract are useful for diagnosis and treatment. CONCLUSION Pharmacobezoars are rarely seen in clinical and forensic practice. They are related to controlled or immediate-release formulations, liquid, or non-digestible substances, in normal or altered digestive motility/anatomy tract, and in overdoses or therapeutic doses, and should be suspected in the presence of risk factors or patients taking drugs which may form pharmacobezoars.
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Affiliation(s)
- Francisco Basílio
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
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7
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Kolesar JM, Andrews S, Green H, Havighurst TC, Wollmer BW, DeShong K, Laux DE, Krontiras H, Muccio DD, Kim K, Grubbs CJ, House MG, Parnes HL, Heckman-Stoddard BM, Bailey HH. A Randomized, Placebo-Controlled, Double-Blind, Dose Escalation, Single Dose, and Steady-State Pharmacokinetic Study of 9cUAB30 in Healthy Volunteers. Cancer Prev Res (Phila) 2019; 12:903-912. [PMID: 31484659 DOI: 10.1158/1940-6207.capr-19-0310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/04/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
9cUAB30 is a synthetic analogue of 9-cis retinoic acid with chemoprevention activity in cell lines and animal models. The purpose of this phase I placebo-controlled, double-blinded, dose escalation study of 9cUAB30 was to evaluate its safety, pharmacokinetics, and determine a dose for future phase II studies. Participants received a single dose of study drug (placebo or 9cUAB30) on day 1 followed by a 6-day drug-free period and then 28 days of continuous daily dosing starting on day 8. Fifty-three healthy volunteers were enrolled into five dose cohorts (20, 40, 80, 160, and 240 mg). Participants were randomized within each dose level to receive either 9cUAB30 (n = 8) or placebo (n = 2). 9cUAB30 was well tolerated, with no dose limiting toxicities reported and no evidence of persistent elevations in serum triglycerides or cholesterol. Treatment-emergent grade 3 hypertension occurred in 1 of 8 participants at the 20 mg dose level and in 2 of 8 at the 240 mg dose level, all considered unlikely related to study agent; no other grade 3 adverse events were observed. The AUC increased, as expected, between day 1 (single dose) and day 36 (steady state). Pharmacokinetics were linear in dose escalation through 160 mg. 9cUAB30 administered by daily oral dosing has a favorable safety and pharmacokinetic profile. On the basis of the observed safety profile and lack of linearity in pharmacokinetics at doses greater than 160 mg, the recommended phase II dose with the current formulation is 160 mg once daily.
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Affiliation(s)
- Jill M Kolesar
- College of Pharmacy, University of Kentucky, Lexington, Kentucky. .,University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Shannon Andrews
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Heather Green
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Tom C Havighurst
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | | | - Katina DeShong
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Douglas E Laux
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Helen Krontiras
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donald D Muccio
- Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - KyungMann Kim
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.,Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Clinton J Grubbs
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret G House
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Howard L Parnes
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | | | - Howard H Bailey
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin. .,Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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8
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Paschos KA, Chatzigeorgiadis A. Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol 2019; 32:224-232. [PMID: 31040619 PMCID: PMC6479654 DOI: 10.20524/aog.2019.0370] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Bezoars are intraluminal conglomerates of indigestible foreign materials that accumulate in the gastrointestinal (GI) tract. They consist of vegetable or fruit fibers, hairs or other substances; accordingly, bezoars are classified as phytobezoars, trichobezoars, pharmacobezoars, etc. Although sometimes asymptomatic, bezoars may cause serious symptoms, such as abdominal discomfort or pain, dysphagia, hematemesis, or even life-threatening entities (GI bleeding, obstruction or perforation). Current technological applications have contributed to the diagnostic and therapeutic approach to these masses, mainly through endoscopic techniques able to diagnose, fragment and extract bezoars, as well as laparoscopic and other surgical modalities that may be used to treat serious complications. Although bezoars were described centuries ago and the term was officially introduced in the mid nineties by Quain, they are still a demanding pathological entity. Their pathophysiology, accurate and prompt diagnosis, as well as successful and minimally invasive treatment, remain under investigation and see continuous progress. Current advances in these challenging areas are discussed in this review, which attempts to present an in-depth study of bezoars along with the well-established modalities and techniques.
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9
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von Düring S, Challet C, Christin L. Endoscopic removal of a gastric pharmacobezoar induced by clomipramine, lorazepam, and domperidone overdose: a case report. J Med Case Rep 2019; 13:45. [PMID: 30808405 PMCID: PMC6391823 DOI: 10.1186/s13256-019-1984-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/16/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Gastric pharmacobezoars are a rare entity that can induce mechanical gastric outlet obstructions and sometimes prolong toxic pharmacological effects. Certain medications, such as sustained-release forms, contain cellulose derivatives that may contribute to the adhesion between pills and lead to the creation of an aggregate resulting in a pharmacobezoar. Case reports are rare, and official guidelines are needed to help medical teams choose proper treatment options. Case presentation Our patient was a 40-year-old Caucasian woman with borderline personality disorder and active suicidal thoughts who was found unconscious after a massive drug consumption of slow-release clomipramine, lorazepam, and domperidone. On her arrival in the emergency room, endotracheal intubation was preformed to protect her airway, and a chest x-ray revealed multiple coffee grain-sized opaque masses in the stomach. She was treated with activated charcoal followed by two endoscopic gastric decontaminations 12 h apart in order to extract a massive gastric pharmacobezoar by manual removal of the tablets. Conclusion This case demonstrates that in the case of a massive drug consumption, a pharmacobezoar should be suspected, particularly when cellulose-coated pills are ingested. Severe poisoning due to delayed drug release from the gastric aggregate is a potential complication. Detection by x-ray is crucial, and treatment is centered on removal of the aggregate. The technique of decontamination varies among experts, and no formal recommendations exist to date. It seems reasonable that endoscopic evaluation should be performed in order to determine the appropriate technique of decontamination. Care should be patient-oriented and take into account the clinical presentation and any organ failure, and it should not be determined solely by the suspected medication ingested. Thus, serum levels are not sufficient to guide management of tricyclic antidepressant intoxication.
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Affiliation(s)
- Stephan von Düring
- Department of Internal Medicine, Emergency Medicine and Critical Care Medicine, Groupement Hospitalier de l'Ouest Lémanique (GHOL), Nyon Hospital, Chemin Monastier 10, 1260, Nyon, Switzerland.
| | - Corinne Challet
- Department of Pharmacy, Pharmacie Interhospitalière de la Côte, Chemin du Crêt 2, 1110, Morges, Switzerland
| | - Laurent Christin
- Department of Internal Medicine, Emergency Medicine and Critical Care Medicine, Groupement Hospitalier de l'Ouest Lémanique (GHOL), Nyon Hospital, Chemin Monastier 10, 1260, Nyon, Switzerland
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Labarinas S, Meulmester K, Greene S, Thomas J, Virk M, Erkonen G. Extracorporeal Cardiopulmonary Resuscitation After Diphenhydramine Ingestion. J Med Toxicol 2018; 14:253-256. [PMID: 29956117 DOI: 10.1007/s13181-018-0672-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/14/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Diphenhydramine is a widely used first-generation histamine (H1) antagonist that can be obtained without prescription in many countries. Massive ingestions can result in severe toxicity and even death. We describe a case of diphenhydramine overdose leading to cardiac arrest, cardiopulmonary resuscitation (CPR), and extracorporeal membrane oxygenation (ECMO) cannulation for refractory ventricular fibrillation, a process we refer to as extracorporeal cardiopulmonary resuscitation (ECPR). CASE REPORT Responding to a call for altered mental status, emergency medical service (EMS) personnel found an unconscious and seizing 17-year-old male. He had reportedly developed generalized tonic-clonic seizures and dysrhythmias after ingesting approximately 800 25-mg diphenhydramine tablets. He was transferred to our pediatric intensive care unit (PICU) after stabilization at a local emergency center. After approximately 7 hours of clinical stability and normalization of cardiac rhythm, electrolytes, and acidosis, he developed renewed seizure activity and accelerated ventricular rhythm leading to hemodynamic collapse and cardiac arrest. He was cannulated for veno-arterial extracorporeal membrane oxygenation (VAECMO) with CPR in progress. A pharmacobezoar located in his stomach was presumed to be the cause of his biphasic clinical deterioration. After 5 days, the patient was successfully weaned from ECMO support. Ten days later, his convalescence continued in the step-down unit and was discharged with good functional outcome. DISCUSSION Significant ingestion of anticholinergic substances is often fatal. This case describes a favorable outcome after ECPR and aggressive supportive management following a large intentional overdose of diphenhydramine.
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Affiliation(s)
- Sonia Labarinas
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Houston, TX, 77030, USA.
| | - Kristen Meulmester
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Houston, TX, 77030, USA
| | - Spencer Greene
- Department of Emergency Medicine, Baylor College of Medicine, Ben Taub Hospital, 1504 Taub Loop, Houston, TX, 77030, USA
| | - James Thomas
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Houston, TX, 77030, USA
| | - Manpreet Virk
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Houston, TX, 77030, USA
| | - Gwen Erkonen
- Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Houston, TX, 77030, USA
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When a cure becomes the pathology: mechanical bowel obstruction due to herbal pharmacobezoar. A case report with review of literature. Clin J Gastroenterol 2018; 11:396-400. [PMID: 29680980 DOI: 10.1007/s12328-018-0861-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/14/2018] [Indexed: 10/17/2022]
Abstract
Bezoars are intra-luminal concretions of ingested material which accumulate within the bowel. They are termed pharmacobezoars when the constituent material is drugs. We report a 64-year-old female with abdominal pain and obstipation for 3 days. Patient had completed anti-tuberculous combination therapy for suspected abdominal tuberculosis 25 years ago. She exhibited features of shock with a right iliac fossa lump. Abdominal X-ray displayed multiple air-fluid levels with densely cluttered radio-opacities in the right lower quadrant. Laparotomy revealed a palpable mid-ileal intra-luminal lump, adherent to the ascending colon and proximal ileum necessitating resection. Ex vivo examination of resected specimen revealed numerous tablets aggregating proximal to an ileal stricture. The patient post-operatively confirmed the tablets resembled the herbal laxatives she had been consuming. Pharmacobezoars can lead to subacute intestinal obstruction. Numerous drugs have been implicated. Patients with partial gastrectomy and vagotomy are at risk. CT is the pre-eminent diagnostic modality. The treatment options for pharmacobezoars include lavage, endoscopic retrieval, in addition to surgery. Pharmacobezoars need a high index of suspicion for pre-operative diagnosis. A detailed history and correlation with radioimaging can offer important cues. One can prevent pharmacobezoars by abstaining from unwarranted medications and identifying those at risk.
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12
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Small Bowel Obstruction Secondary to a Metamucil Bezoar: Case Report and Review of the Literature. Case Rep Surg 2017; 2017:2702896. [PMID: 29085697 PMCID: PMC5632449 DOI: 10.1155/2017/2702896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/17/2017] [Indexed: 12/29/2022] Open
Abstract
Bezoar-induced small bowel obstruction is a rare entity. It should be highly suspected in patients with gastric hypomotility disorders, psychiatric conditions, prior abdominal or bariatric surgery, or improper intake of medication. Their diagnosis is quite challenging and surgical exploration remains the best treatment of choice to ensure the viability of the small bowel tissue and relieve the obstruction. This is a case of a 48-year-old female with no previous abdominal surgery who presented with acute abdominal pain. The patient's history was remarkable for the daily ingestion of 1.5 teaspoons of Metamucil with minimal amount of water. Computed tomography scan demonstrated dilated small bowel loops and a transition zone at the level of the mid jejunum. On laparoscopy, the patient was found to have a hard mass in the mid jejunum amenable to gentle fragmentation and breakdown. Metamucil bezoars are due to the solidification of psyllium-based substances in the gastrointestinal tract. The usual management of small bowel obstruction induced by a bezoar is exploratory laparotomy with enterotomy and primary anastomosis. Laparoscopic intervention has gained popularity among surgeons with good outcome and lower morbidity. In this unusual case, the small bowel obstruction induced by the Metamucil bezoar was safely treated with laparoscopic fragmentation alone.
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13
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Sheikh AB, Akhtar A, Nasrullah A, Haq S, Ghazanfar H. Role of Laparoscopy in the Management of Acute Surgical Abdomen Secondary to Phytobezoars. Cureus 2017; 9:e1363. [PMID: 28721331 PMCID: PMC5513738 DOI: 10.7759/cureus.1363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A bezoar is a collection of indigestible material found in the alimentary canal, which can cause mechanical obstruction of the gastrointestinal tract. Phytobezoar is a variant composed of mostly plant material and indigestible fiber. Phytobezoar is a rare cause of small bowel obstruction (SBO) and happens more commonly in patients with risk factors predisposing to impaired gastrointestinal motility. We present a rare case of SBO secondary to phytobezoar in a 60-year-old female patient with type 2 diabetes. There was no prior history of any abdominal surgery. The abdominal computed tomography (CT) scan was inconclusive. Laparoscopy was found to be an effective diagnostic and therapeutic procedure in this patient.
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Affiliation(s)
| | - Aisha Akhtar
- Surgery, Texas Tech Health Sciences Center Lubbock
| | - Adeel Nasrullah
- Department of Internal Medicine, Shifa International Hospital
| | - Shujaul Haq
- Department of Internal Medicine, Shifa International Hospital
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14
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Parker V, Goldberg D, King MA. Case 1: Mysteriously Rising Salicylate Levels in a 15-year-old Girl. Pediatr Rev 2017; 38:280-281. [PMID: 28572137 DOI: 10.1542/pir.2014-0129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Marta A King
- Cardinal Glennon Children's Hospital, St Louis, MO
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15
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Hopkins LE, Sunkersing J, Jacques A. Too many pills to swallow: A case of a mixed overdose. J Intensive Care Soc 2017; 18:247-250. [PMID: 29118840 DOI: 10.1177/1751143717693860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Propranolol is a highly lipid-soluble beta-receptor antagonist. We describe a case of mixed overdose, including propranolol, amlodipine and olanzapine, resulting in severe resistant hypotension which was successfully treated. A 21-year-old student ingested 6.4 g of propranolol, 280 mg of amlodipine and 560 mg of olanzapine. The patient was brought to the emergency department and exhibited signs of severe systemic toxicity - profound hypotension and circulatory collapse, respiratory depression and coma. The patient had conventional therapy but failed to respond to this and was therefore commenced on IntraLipid infusion, high-dose insulin infusion and inotrope infusion. An endoscopy was performed in intensive care which revealed a large drug beozar - this was removed. We believe that this combination of infusions with early endoscopy could be beneficial in treating similar patients in the future and present the first case of a propranolol drug bezoar.
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Affiliation(s)
| | | | - Andrew Jacques
- Intensive Care Unit, Royal Berkshire NHS Foundation Trust, Reading, UK
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Abstract
A 13-year-old female was presented to the emergency department following an intentional ingestion. The patient developed significant toxicity including multiple, discreet tonic-clonic seizures. Despite appropriate resuscitation and antidotal management, the patient's symptoms persisted for more than 36 hours post-ingestion. An upright abdominal radiograph was performed revealing a radiopacity suggesting a pharmacobezoar. An esophagogastroduodenoscopy was performed with successful removal of a tennis ball-sized pharmacobezoar. The patient's symptoms subsequently subsided and she recovered fully with no neurologic deficits. Diphenhydramine has not been previously identified as a medication likely to form a pharmacobezoar and has not been shown to be radiopaque. Though bezoar formation is a rare clinical scenario, it is one that toxicologists must consider in patients with clinical courses that persist far beyond expected based on known toxicokinetic principles.
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Affiliation(s)
- Jami Johnson
- a Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy , Oklahoma City , OK , USA
| | - Kristie Williams
- a Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy , Oklahoma City , OK , USA
| | - William Banner
- a Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy , Oklahoma City , OK , USA.,b Pediatric Services, Pediatric Critical Care and Toxicology , Integris Baptist Medical Center , Oklahoma City , OK , USA
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17
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Vega-Mata N, Fernández-García L, Lara-Cardenas C, Raposo-Rodríguez L, Montes-Granda M. [Paediatric pharmacobezoar in vitamin overdose]. CIR CIR 2017; 85 Suppl 1:30-33. [PMID: 28041610 DOI: 10.1016/j.circir.2016.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/09/2016] [Accepted: 11/25/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pharmacobezoars are aggregates of undigested medications that accumulate in the gastrointestinal tract and can cause obstructive or toxic complications. In this paper, the first case is reported of a paediatric pharmacobezoar formation after a vitamin overdose. The objective of this report is to prevent the occurrence of this complication and the action to be taken. CLINIC CASE A 6-year-old child, 6h after ingesting 40 chewable tablets of a hydrophobic vitamin E with high capacity to form a pharmacobezoar, underwent urgent oesophagogastroscopy. A viscoelastic mass of 10×4cm was observed stretching from the cardia to the greater curvature. Seventy-five percent of the mass was removed and the remainder was fragmented, hydrated and aspirated. The patient remains asymptomatic to date. CONCLUSIONS An overdose of hydrophobic drugs can produce a bezoar formation therefore prompt evacuation is recommended with an upper gastrointestinal endoscopy, which is a safe and effective technique in gastric bezoars.
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Affiliation(s)
- Nataliz Vega-Mata
- Servicio de Cirugía Pediátrica, Hospital Universitario Central de Asturias, Oviedo, España.
| | - Laura Fernández-García
- Servicio de Cirugía Pediátrica, Hospital Universitario Central de Asturias, Oviedo, España
| | - Carolina Lara-Cardenas
- Servicio de Cirugía Pediátrica, Hospital Universitario Central de Asturias, Oviedo, España
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18
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Gavala A, Manou D, Psalida V, Nystatzaki M, Mavrogiannis C, Alevizopoulos G, Myrianthefs P. Methadone Gastrobezoar in a Psychiatric Patient Presented in Coma. Indian J Crit Care Med 2017; 21:796-798. [PMID: 29279645 PMCID: PMC5699012 DOI: 10.4103/ijccm.ijccm_17_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 43-year-old psychiatric patient was transferred in coma and hypercapnic respiratory failure at the emergency department. He was intubated for airway protection and transferred to the Intensive Care Unit (ICU). Abdominal X-ray revealed a radiopaque mass; a pharmacobezoar was suspected and confirmed by gastroscopy; one large in the stomach fundus and a smaller one in the pylorus. Gastric lavage through the gastroscope and administration of gastro-kinetic drugs and laxatives were able to dilute the bezoars. Tablets retrieved from the stomach identified as methadone and toxicological tests of the gastric fluid confirmed the presence of methadone as the only organic chemical compound. The patient was extubated on the 7th day and released from the ICU on the 10th day under psychiatric consultation having normal vital signs. Methadone gastric bezoar may lead to persistent intoxication, respiratory failure, and coma requiring ICU care. Diagnosis may be difficult and a high index of suspicion is needed.
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Affiliation(s)
- Alexandra Gavala
- Department of Intensive Care Unit, Kaliftaki, 14564, Nea Kifissia, Greece
| | - Despoina Manou
- Department of Gastrenterology, Kaliftaki, 14564, Nea Kifissia, Greece
| | - Vasiliki Psalida
- Department of Intensive Care Unit, Kaliftaki, 14564, Nea Kifissia, Greece
| | - Maria Nystatzaki
- Department of Psychiatry at "Agioi Anargyroi" General Hospital, Kaliftaki, 14564, Nea Kifissia, Greece
| | - Christos Mavrogiannis
- Department of Gastrenterology, Kaliftaki, 14564, Nea Kifissia, Greece.,Faculty of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - George Alevizopoulos
- Department of Psychiatry at "Agioi Anargyroi" General Hospital, Kaliftaki, 14564, Nea Kifissia, Greece.,Faculty of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Pavlos Myrianthefs
- Department of Intensive Care Unit, Kaliftaki, 14564, Nea Kifissia, Greece.,Faculty of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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19
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Mortensen KE, Munkholm J, Dalhoff KP, Hoegberg LCG. Oesophageal Obstruction from a Pharmacobezoar Resulting in Death. Basic Clin Pharmacol Toxicol 2016; 120:213-216. [DOI: 10.1111/bcpt.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Julie Munkholm
- Section of Forensic Pathology; Department of Forensic Medicine; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
- The Danish Poisons Information Centre; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
| | - Lotte Christine Groth Hoegberg
- The Danish Poisons Information Centre; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
- Department of Anaesthesiology; Copenhagen University Hospital Bispebjerg; Copenhagen Denmark
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20
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Vlad I, Armstrong J, Ridgley J, Pascu O. Dabigatran deliberate overdose: two cases and suggestions for laboratory monitoring. Clin Toxicol (Phila) 2016; 54:286-9. [PMID: 26735702 DOI: 10.3109/15563650.2015.1126287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Dabigatran etexilate (dabigatran) is a direct thrombin inhibitor anticoagulant agent. There is limited information about the changes in coagulation profile and outcomes in overdose. A monoclonal antibody has been developed to neutralize the anticoagulant effect of dabigatran. Case reports describe enhanced clearance of dabigatran by haemodialysis as an intervention to prevent haemorrhagic complications - however, the threshold for initiating haemodialysis is not well defined in an asymptomatic patient with normal renal function. CASE DETAILS Two patients presented following deliberate dabigatran overdoses. A 55-year-old woman ingested 10 × 150 mg dabigatran. A 21-year-old woman with a history of systemic lupus erythematosus and pulmonary embolus ingested 100 × 110 mg dabigatran. Both were admitted to the intensive care unit and managed expectantly. Serial coagulation tests normalized over 60 h. The half-life of dabigatran was not prolonged following overdose, being calculated between 7 and 11 h in each case. There was positive correlation between international normalized ratio (INR), prothrombin time (PT) and activated partial thromboplastin time (aPTT) with plasma dabigatran levels. CONCLUSION There is limited experience with dabigatran overdoses. Normal aPTT, PT and INR assays 12 h following deliberate ingestion indicate that the drug concentration is not high. Individual risk assessment of bleeding risk needs to be formulated for each patient and expectant management is reasonable in the presence of normal renal function and absent risk factors for bleeding.
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Affiliation(s)
- Ioana Vlad
- a Emergency Department , Sir Charles Gairdner Hospital , Perth , Australia
| | - Jason Armstrong
- a Emergency Department , Sir Charles Gairdner Hospital , Perth , Australia
| | - James Ridgley
- b Intensive Care Unit, Joondalup Hospital , Perth , Australia
| | - Ovidiu Pascu
- a Emergency Department , Sir Charles Gairdner Hospital , Perth , Australia
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21
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Erdemir A, Ağalar F, Çakmakçı M, Ramadan S, Baloğlu H. A rare cause of mechanical intestinal obstruction: Pharmacobezoar. ULUSAL CERRAHI DERGISI 2015; 31:92-3. [PMID: 26170758 DOI: 10.5152/ucd.2014.2749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/28/2014] [Indexed: 11/22/2022]
Abstract
A bezoar is a hard, and solid, foreign body located in the gastrointestinal tract that may recur. Bezoar is classified according to its origin. Pharmacobezoars develop in the gastrointestinal tract due to alterations in anatomical structure and/or intestinal motility. In this paper, a case, not yet defined in the literature, of a pharmacobezoar causing a mechanical obstruction that is accompanied by a malignancy in the colon is reported, with the aim of contributing to the literature.
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Affiliation(s)
- Ayhan Erdemir
- Department of General Surgery, Anatolia Health Center, Kocaeli, Turkey
| | - Fatih Ağalar
- Department of General Surgery, Anatolia Health Center, Kocaeli, Turkey
| | - Metin Çakmakçı
- Department of General Surgery, Anatolia Health Center, Kocaeli, Turkey
| | - Saime Ramadan
- Department of Pathology, Anatolia Health Center, Kocaeli, Turkey
| | - Hüseyin Baloğlu
- Department of Pathology, Anatolia Health Center, Kocaeli, Turkey
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22
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Livshits Z, Sampson BA, Howland MA, Hoffman RS, Nelson LS. Retained drugs in the gastrointestinal tracts of deceased victims of oral drug overdose. Clin Toxicol (Phila) 2014; 53:113-8. [PMID: 25547175 DOI: 10.3109/15563650.2014.992528] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT The extent of non-absorbed drug burden in the GI tract following overdose is unknown. Patients who present with clinical signs of toxicity may not undergo decontamination due to assumption that the drug has already been completely absorbed and because of limited scientific evidence of benefit for routine GI decontamination in poisoned patients. OBJECTIVE The goal of this study was to assess whether people who die of an oral overdose have unabsorbed drug present in the GI tract. The secondary goal was to analyze pharmacologic characteristics of retained drugs when present. MATERIALS AND METHODS Retrospective review of autopsy reports from 2008 to 2010, whose cause of death was determined as "intoxication" or "overdose, was performed at the Office of Chief Medical Examiner of the City of New York (OCME NYC)." Decedents of all ages were identified via electronic OCME database. Inclusion criteria were as follows: 1) cause of death "intoxication" or "overdose" noted by forensic autopsy, 2) ingestion of a solid drug formulation. RESULTS 92 out of 1038 autopsies (9%) that met inclusion criteria had documentation of retained pill fragments, granules, paste, sludge, slurry, or whole pills in the GI tract. The most common drugs found were opioids and anticholinergics. Ninety-eight percent (98%) of the retained drugs were either modified-release preparations or drugs known to slow GI transit. Most decedents were dead on arrival; there were twelve in-hospital deaths and eleven patients died in the Emergency Department. Bupropion and venlafaxine were responsible for four deaths in those who received medical care. One person died in the ICU following bupropion ingestion. DISCUSSION AND CONCLUSION Overdose of an oral drug that either has modified-release properties or slows GI tract motility may result in substantial unabsorbed drug burden remaining in the GI tract.
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Affiliation(s)
- Z Livshits
- Division of Emergency Medicine, Department of Medicine, New York Presbyterian Weill Cornell Medical Center , New York, NY , USA
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23
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England G, Heath KJ, Gilbert JD, Byard RW. Forensic features of pharmacobezoars. J Forensic Sci 2014; 60:341-5. [PMID: 25537433 DOI: 10.1111/1556-4029.12679] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/24/2014] [Indexed: 02/07/2023]
Abstract
Three cases of pharmacobezoars are reported to demonstrate typical autopsy findings and potential lethal mechanisms: (i) A 32-year-old woman died following an overdose of prescription medications. A gelatinous pharmacobezoar was found forming a cast of her bronchial tree. (ii) A 24-year-old woman also died following an overdose of prescription medications. At autopsy, two pharmacobezoars were present, one within the larynx and another occluding the right main bronchus. Deaths in both cases were attributed to airway occlusion by pharmacobezoars complicating mixed drug toxicity. (iii) A 79-year-old man was found dead in a car. Death was attributed to the combined effects of carbon monoxide and drug toxicity with a large pharmacobezoar lodged within the esophagus. Pharmacobezoars are specific types of bezoars that occur when pharmaceutical materials, such as tablets, suspensions, and/or drug delivery devices, aggregate and contribute to death by occluding airways with tenacious material or by eluting drugs.
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Affiliation(s)
- Georgina England
- Forensic Science SA, 21 Divett Place, Adelaide, SA, 5000, Australia
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24
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Tungaraza TE, Talapan-Manikoth P, Jenkins R. Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry. Ther Adv Drug Saf 2014; 4:63-71. [PMID: 25083252 DOI: 10.1177/2042098612474681] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Orally taken tablets in different formulations continue to have a central role in the treatment of various psychiatric and medical conditions. In order to improve compliance, reduce the frequency of taking medications and minimize the peaks and troughs associated with certain immediate-release formulations, pharmaceutical companies have developed a number of novel methods of delivering oral solid dosage medications in the form of controlled-release (CR) formulations. Some CR formulations have been associated with pharmacobezoars and false-positive findings on certain physical investigations. Though CR drugs are commonly used in psychiatry, clinicians appear to have a limited understanding of how they are released for absorption once ingested. Some have insoluble parts that are excreted in faeces as 'ghost pills'. Due to lack of awareness of this phenomenon to both patients and the physicians, anxiety has ensued in some patients. Some clinicians have been puzzled or have been dismissive when faced with curious patients wanting to know more after they had observed tablet-like looking structures in faeces. We present two cases from our clinical setting and a few drawn from the World Wide Web to highlight the role of CR medications and their association with the ghost pill phenomenon. The mechanisms involved in drug release relevant to psychiatry medications are also briefly reviewed. The ghost pill phenomenon occurs with certain CR medications. This is a normal and expected outcome related to drug-release mechanisms of some of these products. It is inevitable that some patients will see what looks like tablets or capsules in faeces. Raising awareness of this phenomenon among clinicians would facilitate discussions and information sharing at the initial process of medication prescribing. Awareness among patients and carers would also help to allay anxiety.
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Affiliation(s)
- Tongeji Elifazi Tungaraza
- Black Country Partnership Foundation Trust - Psychiatry, Penn Hospital, Penn Road, Wolverhampton WV4 5HN, UK
| | | | - Rosemary Jenkins
- Black Country Partnership Foundation Trust - Psychiatry, Penn Hospital, Wolverhampton, UK
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25
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Durand G, Clouzeau J, Jegou MJ, Gallart JC. Pharmacobézoard au cours d’une intoxication massive à la clomipramine. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0429-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Rauber-Lüthy C, Hofer KE, Bodmer M, Kullak-Ublick GA, Kupferschmidt H, Ceschi A. Gastric pharmacobezoars in quetiapine extended-release overdose: A case series. Clin Toxicol (Phila) 2013; 51:937-40. [DOI: 10.3109/15563650.2013.856442] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Magdalan J, Zawadzki M, Słoka T, Sozański T. Suicidal overdose with relapsing clomipramine concentrations due to a large gastric pharmacobezoar. Forensic Sci Int 2013; 229:e19-22. [DOI: 10.1016/j.forsciint.2013.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/10/2013] [Accepted: 03/15/2013] [Indexed: 11/28/2022]
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29
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Pharmacobezoar in a patient on an oral phosphate binder. Gastrointest Endosc 2013; 77:511-2. [PMID: 23410703 DOI: 10.1016/j.gie.2012.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 11/01/2012] [Indexed: 12/11/2022]
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30
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Gastric electrical stimulation for the treatment of obesity: from entrainment to bezoars-a functional review. ISRN GASTROENTEROLOGY 2013; 2013:434706. [PMID: 23476793 PMCID: PMC3582063 DOI: 10.1155/2013/434706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/08/2013] [Indexed: 12/29/2022]
Abstract
GROWING WORLDWIDE OBESITY EPIDEMIC HAS PROMPTED THE DEVELOPMENT OF TWO MAIN TREATMENT STREAMS: (a) conservative approaches and (b) invasive techniques. However, only invasive surgical methods have delivered significant and sustainable benefits. Therefore, contemporary research exploration has focused on the development of minimally invasive gastric manipulation methods featuring a safe but reliable and long-term sustainable weight loss effect similar to the one delivered by bariatric surgeries. This antiobesity approach is based on placing external devices in the stomach ranging from electrodes for gastric electrical stimulation to temporary intraluminal bezoars for gastric volume displacement for a predetermined amount of time. The present paper examines the evolution of these techniques from invasively implantable units to completely noninvasive patient-controllable implements, from a functional, rather than from the traditional, parametric point of view. Comparative discussion over the available pilot and clinical studies related to gastric electrical stimulation outlines the promises and the fallacies of this concept as a reliable alternative anti-obesity strategy.
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31
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Kotzampassi K, Grosomanidis V. Pharmacobezoar in an obese patient with intragastric balloon: a case revealed at endoscopy. Clin Obes 2012; 2:168-70. [PMID: 25586252 DOI: 10.1111/cob.12003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/09/2012] [Accepted: 11/13/2012] [Indexed: 11/28/2022]
Abstract
Pharmacobezoar formation is a very rare complication that occurs in cases of altered gastrointestinal motility or to a background of disturbed anatomy of the gastrointestinal tract. The case of an obese and depressed patient treated by an intragastric balloon for weight loss, who was revealed to have a pharmacobezoar during endoscopy for early balloon removal, is presented. The possible causes of pharmacobezoar formation in such a patient treated with an intragastric balloon are discussed.
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Affiliation(s)
- K Kotzampassi
- Department of Surgery, Aristotle's University of Thessaloniki, Thessaloniki, Greece
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