Sato Chie, Kamijo Yoshito
Department of Emergency and Critical Care Medicine, School of Medicine Kitasato University Sagamihara Japan.
Acute Med Surg. 2014 Jul 14;2(1):60-63. doi: 10.1002/ams2.58. eCollection 2015 Jan.
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.
On day 30, the patient was transferred to the Psychiatric Department.
An intragastric pharmacobezoar should be suspected in patients with promoted and prolonged toxicity or if high serum concentrations of agents indicate their continuous absorption.
一名49岁男性摄入了大量的维他命A®片剂，该片剂除含有苯巴比妥外，还含有两种抗胆碱能药物。患者在住院4天后仍处于意外延长的昏迷状态。急性胃镜检查发现胃小弯处有一个粉白色的药物性胃石，用网将其取出。随后开始进行直接血液灌流并使用多剂量活性炭治疗。苯巴比妥血清浓度最终下降，患者完全康复。
在第30天，患者被转至精神科。
对于中毒症状加重且持续时间延长的患者，或血清中药物浓度较高表明其持续吸收的患者，应怀疑胃内有药物性胃石。
