Opioid Overdose and Serotonin Syndrome due to Gastric Bezoar in a Woman with Autism and Pica Behaviour

Palimaru, Iolanda; Guetta, Michaël; Cravero, Cora; Fron, Clémence; Cohen, David; Giannitelli, Marianna

doi:10.1155/2021/7334467

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…In our sample, 8 out of 20 patients (40%) presented this condition. Although its general prevalence in ASD patients is not well established, it seems to be relatively frequent and regularly neglected as an important comorbidity of the spectrum, even though every so often it may lead to important health problems, such as choking, gastrointestinal obstructions or perforations, parasitic infections and poisoning ( 17 – 19 , 87 – 90 ). ASD-associated Pica is generally refractory to medications, and the most effective treatment involves behavioral modeling by applied behavioral analysis therapy (ABA) ( 87 ).…”

Section: Discussionmentioning

confidence: 99%

Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits

Montagner,

Medeiros,

da Silva

et al. 2023

Front. Psychiatry

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Autism Spectrum Disorders (ASD) may significantly impact the well-being of patients and their families. The therapeutic use of cannabis for ASD has gained interest due to its promising results and low side effects, but a consensus on treatment guidelines is lacking. In this study, we conducted a retrospective analysis of 20 patients with autistic symptoms who were treated with full-spectrum cannabis extracts (FCEs) in a response-based, individually-tailored dosage regimen. The daily dosage and relative proportions of cannabidiol (CBD) and tetrahydrocannabinol (THC) were adjusted based on treatment results following periodic clinical evaluation. Most patients (80%) were treated for a minimum of 6 months. We have used a novel, detailed online patient- or caregiver-reported outcome survey that inquired about core and comorbid symptoms, and quality of life. We also reviewed patients’ clinical files, and no individual condition within the autistic spectrum was excluded. This real-life approach enabled us to gain a clearer appraisal of the ample scope of benefits that FCEs can provide for ASD patients and their families. Eighteen patients started with a CBD-rich FCE titrating protocol, and in three of them, the CBD-rich (CBD-dominant) FCE was gradually complemented with low doses of a THC-rich (THC-dominant) FCE based on observed effects. Two other patients have used throughout treatment a blend of two FCEs, one CBD-rich and the other THC-rich. The outcomes were mainly positive for most symptoms, and only one patient from each of the two above-mentioned situations displayed important side effects one who has used only CBD-rich FCE throughout the treatment, and another who has used a blend of CBD-Rich and THC-rich FCEs. Therefore, after FCE treatment, 18 out of 20 patients showed improvement in most core and comorbid symptoms of autism, and in quality of life for patients and their families. For them, side effects were mild and infrequent. Additionally, we show, for the first time, that allotriophagy (Pica) can be treated by FCEs. Other medications were reduced or completely discontinued in most cases. Based on our findings, we propose guidelines for individually tailored dosage regimens that may be adapted to locally available qualified FCEs and guide further clinical trials.

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Section: Discussionmentioning

confidence: 99%

Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits

Montagner,

Medeiros,

da Silva

et al. 2023

Front. Psychiatry

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Sertraline/tramadol

2022

Reactions Weekly

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A 38-year-old woman developed serotonin syndrome during treatment with sertraline as an anxiolytic and tramadol for pain [routes not stated].The woman, who had nonverbal autism, epilepsy and intellectual disability, was admitted to the hospital due to severe Pica behaviour for three years. She had a history of vitamin B9 deficiency, iron deficiency and gastric ulcer. Following a period of observation, a problematic behaviour was observed, which involved ingestion of inedible foreign objects. She required constant monitoring. Investigations revealed a gastric bezoar with multiple plastic foreign bodies. The bezoar could not be removed, because of a technical problem. During the course of hospitalisation, she started receiving sertraline 50 mg/day as anxiolytic along with sodium valproate, diazepam, melatonin, sodium alginate/sodium bicarbonate, lansoprazole and phloroglucinol. After a few weeks, she underwent an intensive behavioural therapy. However, there was deterioration of her general condition. Her compulsive motor activity had intensified, she had pain on abdominal palpation along with diarrhoea. A subocclusive syndrome secondary to severe Pica behaviour was presumed, and she underwent a colonic lavage with polyethylene glycol that allowed the elimination of a medical compress. She started receiving tramadol 225 mg/day for pain. During this episode, the biological assessment revealed an inflammatory syndrome, disturbance of the hepatic assessment, iron deficiency anaemia, cardiac injury and rhabdomyolysis. The viral PCR was positive for coronavirus OC-43. After a day, she presented with profuse sweating. Modified physiological constants were as follows: peripheral temperature 38.2°C, HR 150 beats/minute, systolic arterial pressure 130mm Hg and oxygen saturation in ambient air 91%. During the night, she had several desaturations. The following morning, she was found in a calm coma with a Glasgow score of 3. She was shifted to the ICU. On basis of the investigations, her condition was consistent with serotonin syndrome. Serotonin syndrome was attributed to sertraline and tramadol [duration of treatments to reaction onset not stated].The woman was treated with naloxone, and she responded immediately. Following an immediate response to opioid antidote, tramadol overdose was hypothesised. It was presumed that the presence of gastric bezoar slowed the absorption of tramadol, which led to the overdose of tramadol. After a few hours of antidote administration, she became fully vigilant and her outcome was favourable. She was transferred back to neurodevelopmental unit. After 2 weeks, she underwent an exploratory laparotomy to remove the bezoar. However, bezoar was not detected, the small intestine was not dilated and there was no stenosis. A gastroscopy revealed a free stomach. Spontaneous elimination of foreign bodies was concluded. Following treatment of anaemia by iron supplementation and intensive behavioural therapy, there was an improvement in her Pica behaviour.

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Opioid Overdose and Serotonin Syndrome due to Gastric Bezoar in a Woman with Autism and Pica Behaviour

Cited by 2 publications

References 19 publications

Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits

Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits

Sertraline/tramadol

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