Gastric bezoar following venlafaxine overdose

Djogovic, Dennis; Hudson, Darren; Jacka, Michael J.

doi:10.1080/15563650701517731

Cited by 16 publications

(14 citation statements)

References 7 publications

(4 reference statements)

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“…The case of a cholestyramine pharmacobezoar occurred in a 10-month-old child with intestinal malrotation. Deaths resulted from bowel obstruction, sepsis, multi-organ failure, drug toxicity, and seizures (19,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Forensic Features of Pharmacobezoars

England

Heath

Gilbert

et al. 2014

Journal of Forensic Sciences

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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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Section: Discussionmentioning

confidence: 99%

Forensic Features of Pharmacobezoars

England

Heath

Gilbert

et al. 2014

Journal of Forensic Sciences

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“…This is routinely diagnosed with an abdominal X‐ray, CT scan, or gastroscopy. Removal of the pharmacobezoar by gastroscopy is a common treatment option in clinically stable patients . In a previously published report, an 18‐year‐old woman ingested large amounts of slow‐release theophylline tablets, thereby becoming tremulous and agitated.…”

Section: Discussionmentioning

confidence: 99%

“…A gastroscopy revealed a gelatinous mass of partially dissolved tablets coating the entire greater curvature of the stomach. The pharmacobezoar was removed by multiple gastroscopies using a basket extraction method . In another report, a 28‐year‐old woman who massively ingested slow‐release clomipramine tablets developed a pharmacobezoar in the stomach that was made evident by an abdominal X‐ray, and was subsequently confirmed by gastroscopy and shown to be located in the fundus of the stomach.…”

Section: Discussionmentioning

confidence: 99%

An unexpected prolonged coma due to a pharmacobezoar formed from Vegetamine A® tablet ingestion

Sato

Kamijo

2014

Acute Medicine & Surgery

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Case: A 49-year-old man ingested massive quantities of Vegetamine A® tablets that contain two anticholinergic agents in addition to phenobarbital. The patient remained in an unexpectedly prolonged coma 4 days post-hospitalization. An acute gastroscopy revealed a pinkish-white pharmacobezoar on the lesser curvature of the stomach, which was extracted using a net. Direct hemoperfusion and treatment with multiple-dose activated charcoal was then initiated. Phenobarbital serum concentrations eventually decreased, resulting in complete recovery of the patient.Outcome: On day 30, the patient was transferred to the Psychiatric Department.Conclusion: An intragastric pharmacobezoar should be suspected in patients with promoted and prolonged toxicity or if high serum concentrations of agents indicate their continuous absorption.

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“…The bezoar was diagnosed when high gastric residuals through the first 5 days of her hospital course warranted endoscopic investigation. The patient ultimately suffered devastating cerebrovascular infarcts from multiple seizures and hypoxia from respiratory arrest, aspiration pneumonitis, and acute respiratory distress syndrome [8]. Second, a 39-year-old female who ingested an estimated 30 g of venlafaxine capsules suffered from bowel ischemia and perforation due to persistent, refractory hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…However, since activated charcoal itself is unabsorbable, MDAC risks exacerbation of an existing pharmacobezoar or creation of a new one [2]. Another option, WBI has been utilized with inconsistent success to hasten passage or disruption of a pharmacobezoar [7–8]. If initiated early after a massive ingestion, WBI may prevent bezoar formation altogether.…”

Section: Discussionmentioning

confidence: 99%