Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 21 , ISSUE 11 ( 2017 ) > List of Articles

CASE REPORT

Methadone gastrobezoar in a psychiatric patient presented in coma

Alexandra Gavala, Despoina Manou, Vasiliki Psalida, Maria Nystatzaki, Christos Mavrogiannis, George Alevizopoulos, Pavlos Myrianthefs

Keywords : gastroscopy, intoxication, methadone, pharmacobezoar,Acute care

Citation Information : 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 (11):796-798.

DOI: 10.4103/ijccm.IJCCM_17_17

License: CC BY-ND 3.0

Published Online: 00-11-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


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.


PDF Share
  1. Eng K, Kay M. Gastrointestinal bezoars: History and current treatment paradigms. Gastroenterol Hepatol (N Y) 2012;8:776-8.
  2. Simpson SE. Pharmacobezoars described and demystified. Clin Toxicol (Phila) 2011;49:72-89.
  3. Williams RS. The fascinating history of bezoars. Med J Aust 1986;145:613-4.
  4. Lee J. Bezoars and foreign bodies of the stomach. Gastrointest Endosc Clin N Am 1996;6:605-19.
  5. Taylor JR, Streetman DS, Castle SS. Medication bezoars: A literature review and report of a case. Ann Pharmacother 1998;32:940-6.
  6. Kadian RS, Rose JF, Mann NS. Gastric bezoars – Spontaneous resolution. Am J Gastroenterol 1978;70:79-82.
  7. Buckley NA, Dawson AH, Reith DA. Controlled release drugs in overdose. Clinical considerations. Drug Saf 1995;12:73-84.
  8. Stack PE, Thomas E. Pharmacobezoar: An evolving new entity. Dig Dis 1995;13:356-64.
  9. Höjer J, Personne M. Endoscopic removal of slow release clomipramine bezoars in two cases of acute poisoning. Clin Toxicol (Phila) 2008;46:317-9.
  10. Lapostolle F, Finot MA, Adnet F, Borron SW, Baud FJ, Bismuth C. Radiopacity of clomipramine conglomerations and unsuccessful endoscopy: Report of 4 cases. J Toxicol Clin Toxicol 2000;38:477-82.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.