Pharmacobezoars described and demystified

Clinical Toxicology

Volumn 49, Issue 2, 2011, Pages 72-89

  Simpson, Serge Emile ^a  

^a ALBERT EINSTEIN MEDICAL CENTER   (United States)

Author keywords

Complications of poisoning; Gastrointestinal decontamination; GI; Gut and hepatotoxicity; Organ tissue specific; Other; Pharmaceuticals

Indexed keywords

ACETYLSALICYLIC ACID; ACTIVATED CARBON; ALUMINUM HYDROXIDE; ALUMINUM MAGNESIUM HYDROXIDE; AMITRIPTYLINE; BROMIDE; CLOMIPRAMINE; COLESTYRAMINE; DIGOXIN; IRON; MAGNESIUM OXIDE; MEPROBAMATE; METOPROLOL; NIFEDIPINE; POLYSTYRENESULFONATE SODIUM; POTASSIUM CHLORIDE; QUINIDINE; QUINIDINE SULFATE; SUCRALFATE; THEOPHYLLINE; VENLAFAXINE; VERAPAMIL;

ABDOMINAL DISCOMFORT; ABDOMINAL DISTENSION; ANOREXIA; BEZOAR; BIBLIOGRAPHIC DATABASE; CONFUSION; DRUG TOXICITY AND INTOXICATION; DRUG WITHDRAWAL; EPIGASTRIC PAIN; ESOPHAGUS OBSTRUCTION; HUMAN; HYPERPHOSPHATEMIA; INTESTINE OBSTRUCTION; LETHARGY; MEDLINE; MENTAL HEALTH; NAUSEA; PERITONITIS; PHARMACOBEZOAR; RECTUM HEMORRHAGE; REVIEW; SIDE EFFECT; SMALL INTESTINE OBSTRUCTION; STOMACH OBSTRUCTION; TACHYPNEA; TINNITUS; VOMITING; WEIGHT REDUCTION;

BEZOARS; DATABASES, BIBLIOGRAPHIC; HUMANS; INTESTINAL OBSTRUCTION; PHARMACEUTICAL PREPARATIONS;

EID: 79952410167     PISSN: 15563650     EISSN: 15569519     Source Type: Journal    
DOI: 10.3109/15563650.2011.559472     Document Type: Review

References (84)

1. Andrus CH, Ponsky JL. Bezoars: Classification, pathophysiology, and treatment. Am J Gastroenterol 1988; 83:476-478.
2. Watson WA, Cremer KF, Chapman JA. Gastrointestinal obstruction associated with multiple-dose activated charcoal. J Emerg Med 1986; 4:401-407. (Pubitemid 17219199)
3. Ray MJ, Radin DR, Condie JD, Halls JM. Charcoal bezoar. Smallbowel obstruction secondary to amitriptyline overdose therapy. Dig Dis Sci 1988; 33:106-107.
4. Atkinson SW, Young Y, Trotter GA. Treatment with activated charcoal complicated by gastrointestinal obstruction requiring surgery. BMJ 1992; 305:563.
5. Merriman T, Stokes K. Small bowel obstruction secondary to administration of activated charcoal. Aust N Z J Surg 1995; 65:288-289.
6. Gomez HF, Brent JA, MunozDC4th, Mimmack RF, Ritvo J, Phillips S, McKinney P. Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion. J Emerg Med 1994; 12:57-60. (Pubitemid 24100191)
7. Mizutani T, Naito H, Oohashi N. Rectal ulcer with massive haemorrhage due to activated charcoal treatment in oral organophosphate poisoning. Hum Exp Toxicol 1991; 10:385-386.
8. Goulbourne KB, Cisek JE. Small-bowel obstruction secondary to activated charcoal and adhesions. Ann Emerg Med 1994; 24:108-110. (Pubitemid 24214629)
9. Mauro LS, Nawarskas JJ, Mauro VF. Misadventures with activated charcoal and recommendations for safe use. Ann Pharmacother 1994; 28:915-924. (Pubitemid 24262663)
10. Flores F, Battle WS. Intestinal obstruction secondary to activated charcoal. Contemp Surg 1987; 30:57-59.
11. Chan JC, Saranasuriya C, Waxman BP. Bezoar causing small bowel obstruction after repeated activated charcoal administration. Med J Aust 2005; 183:537. (Pubitemid 41723332)
12. Dorrington CL, Johnson DW, Brant R; for the MDAC Study Group. The frequency of complications associated with the use of multipledose activated charcoal. Ann Emerg Med 2003; 41:370-377. (Pubitemid 36262632)
13. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1999; 37:731-751.
14. Havens W. Intestinal obstruction caused by colloidal aluminum hydroxide. JAMA 1939; 113:1564-1565.
15. Townsend CM Jr, Remmers AR Jr, Sarles HE, Fish JC. Intestinal obstruction from medication bezoar in patients with renal failure. N Engl J Med 1973; 288:1058-1059.
16. Korenman MD, Stubbs MB, Fish JC. Intestinal obstruction from medication bezoars. JAMA 1978; 240:54-55. (Pubitemid 8395573)
17. Girotti MJ, Ruddan J, Cohanim M. Amphojeloma: Antacid impaction in a critically ill patient. Can J Surg 1984; 27:379-380, 382.
18. Potyk D. Intestinal obstruction from impacted antacid tablets. N Engl J Med 1970; 283:134-135.
19. Burruss GL, Van Voorst SJ, Crawford AJ, et al. Small bowel obstruction from an antacid bezoar: A ranitidine-antacid interaction? South Med J 1986; 79:917-918.
20. Portuguez-Malavasi A, Aranda JV. Antacid bezoar in a newborn. Pediatrics 1979; 63:679-680. (Pubitemid 9125492)
21. Baum J. Enteric coated aspirin today. J Rheumatol 1985; 12:829-832. (Pubitemid 16212259)
22. Harris FC. Pyloric stenosis: Hold-up of enteric coated aspirin tablets. Br J Surg 1973; 60:979-981.
23. Sogge MR, Griffith JL, Sinar DR, Mayes GR. Lavage to remove enteric-coated aspirin and gastric outlet obstruction. Ann Intern Med 1977; 87:721-722. (Pubitemid 8262912)
24. Sherry E. Pyloric obstruction caused by aspirin: Case report. N Z Med J 1979; 89:174-175. (Pubitemid 9163312)
25. Springer DJ, Groll A. Poisoning with enteric-coated acetylsalicylic acid complicating gastric outlet obstruction. Can Med Assoc J 1980; 122:1032-1034. (Pubitemid 10081963)
26. Halla JT, Fallahi S, Hardin JG. Acute and chronic salicylate intoxication in a patient with gastric outlet obstruction. Arthritis Rheum 1981; 24:1205-1207. (Pubitemid 11057350)
27. Bogacz K, Caldron P. Enteric-coated aspirin bezoar: Elevation of serum salicylate level by barium study. Case report and review of medical management. Am J Med 1987; 83:783-786.
28. Savitt DL, Hawkins HH, Roberts JR. The radiopacity of ingested medications. Ann Emerg Med 1987; 16:331-339. (Pubitemid 17025754)
29. Iberti TJ, Patterson BK, Fisher CJ Jr. Prolonged bromide intoxication resulting from a gastric bezoar. Arch Intern Med 1984; 144:402-403. (Pubitemid 14186839)
30. Cohen MI, Winslow PR, Boley SJ. Intestinal obstruction associated with cholestyramine therapy. N Engl J Med 1969; 280:1285-1286.
31. 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; 38:477-482. (Pubitemid 30666905)
32. Hojer J, Personne M. Endoscopic removal of slow release clomipramine bezoars in two cases of acute poisoning. Clin Toxicol (Phila) 2008; 46:317-319. (Pubitemid 351431282)
33. Peterson CD, Fifield GC. Emergency gastrotomy for acute iron poisoning. Ann Emerg Med 1980; 9:262-264. (Pubitemid 10037708)
34. Venturelli J, Kwee Y, Morris N, Cameron G. Gastrotomy in the management of acute iron poisoning. J Pediatr 1982; 100:768-769.
35. Landsman I, Bricker JT, Reid BS, Bloss RS. Emergency gastrotomy: Treatment of choice for iron bezoar. J Pediatr Surg 1987; 22:184-185. (Pubitemid 17028242)
36. Foxford R, Goldfrank L. Gastrotomy - a surgical approach to iron overdose. Ann Emerg Med 1985; 14:1223-1226. (Pubitemid 16199759)
37. Bock GW, Tenenbein M. Whole bowel irrigation for iron overdose. Ann Emerg Med 1987; 16:137-138.
38. Tenenbein M. Whole bowel irrigation in iron poisoning. J Pediatr 1987; 111:142-145. (Pubitemid 17092666)
39. Velez LI, Gracia R, Mills LD, Shepherd G, Feng SY. Iron bezoar retained in colon despite 3 days of whole bowel irrigation. J Toxicol Clin Toxicol 2004; 42:653-656. (Pubitemid 39281700)
40. Kaczorowski JM, Wax PM. Five days of whole-bowel irrigation in a case of pediatric iron ingestion. Ann Emerg Med 1996; 27:258-263. (Pubitemid 26055095)
41. TenenbeinM,Wiseman N, Yatscoff RM. Gastrotomy and whole bowel irrigation in iron poisoning. Pediatr Emerg Care 1991; 7:286-288.
42. Ng HW, Tse ML, Lau FL, Chu W. Endoscopic removal of iron bezoar following acute overdose. Clin Toxicol (Phila) 2008; 46:913-915.
43. Tatekawa Y, Nakatani K, Ishii H, Paku S, Kasamatsu M, Sekiya N, Nakano H. Small bowel obstruction caused by a medication bezoar: Report of a case. Surg Today 1996; 26:68-70. (Pubitemid 26064365)
44. Jenis EH, Payne RJ, Goldbaum LR. Acute meprobamate poisoning. A fatal case following a lucid interval. JAMA 1969; 207:361-362.
45. Schwartz HS. Acute meprobamate poisoning with gastrotomy and removal of a drug-containingmass.NEngl J Med 1976; 295:1177-1178.
46. Davis RN, Rettmann JA, Christensen B. Relapsing altered mental status secondary to a meprobamate bezoar. J Trauma 2006; 61:990-991. (Pubitemid 44569444)
47. Eeckhout E, Huyghens L, Loef B, Maes V, Sennesael J. Meprobamate poisoning, hypotension and the Swan-Ganz catheter. Intensive Care Med 1988; 14:437-438.
48. Shepherd MF. Bezoar formed by fragments of extended-release nifedipine tablets. Clin Pharm 1993; 12:849-852. (Pubitemid 23313905)
49. Stack PE, Patel NR, Young MF, Ferslew KE, Thomas E. Pharmacobezoars - the irony of the antidote: First case report of nifedipine XL bezoar. J Clin Gastroenterol 1994; 19:264-265. (Pubitemid 24302048)
50. Georgopoulos S, Gerdes H. Retention of nifedipine extended release tabs in a patient with a colonic stricture. Am J Gastroenterol 1995; 90:2224-2226.
51. Reid T, Rubins JB, Levine J, DeCelles J, Silvis S. Colonic medication bezoar from extended-release nifedipine and procainamide. Arch Fam Med 1995; 4:715-717.
52. Smitz S, Bonnet V, Delporte JP. Severe gastrointestinal dysfunction and retention of extended release nifedipine tablets. J Am Geriatr Soc 1998; 46:656-657. (Pubitemid 28237126)
53. Kwon HY, Scott RL, Mulloy JP. Small bowel Procardia XL tablet bezoar mimicking cystic pneumatosis intestinalis. Abdom Imaging 1996; 21:142-144. (Pubitemid 26094367)
54. Taylor JR, Streetman DS, Castle SS. Medication bezoars: A literature review and report of a case. Ann Pharmacother 1998; 32:940-946. (Pubitemid 28420333)
55. Wells CD, Luckritz TC, Rady MY, Zornik JM, Leighton JA, Patel BM. Bezoar formation requiring endoscopic removal after intentional overdose of extended-release nifedipine. Pharmacotherapy 2006; 26:1802-1805. (Pubitemid 44885334)
56. Niezabitowski LM, Nguyen BN, Gums JG. Extended-release nifedipine bezoar identified one year after discontinuation. Ann Pharmacother 2000; 34:862-864. (Pubitemid 30471267)
57. Yeen WC, Willis IH. Retention of extended release nifedipine capsules in a patient with enteric stricture causing recurrent small bowel obstruction. South Med J 2005; 98:839-842. (Pubitemid 41243689)
58. Bass DM, Prevo M, Waxman DS. Gastrointestinal safety of an extended-release, nondeformable, oral dosage form (OROS): A retrospective study. Drug Saf 2002; 25:1021-1033. (Pubitemid 35397390)
59. Peeters JW, van der Werf SD. Gastric stenosis after potassium chloride ingestion. Endoscopy 1998; 30:S110.
60. Tecklenburg FW, Thomas NJ, Webb SA, Case C, Habib DM. Pediatric ECMO for severe quinidine cardiotoxicity. Pediatr Emerg Care 1997; 13:111-113. (Pubitemid 27174755)
61. Sherman S, Friedman AP, Berdon WE, Haller JO. Kayexalate: A new cause of neonatal bowel opacification. Radiology 1981; 138:63-64. (Pubitemid 11210468)
62. Menke JA, Stallworth RE, Binstadt DH, Strano AJ, Wallace SE. Medication bezoar in a neonate. Am J Dis Child 1982; 136:72-73. (Pubitemid 12202215)
63. Metlay LA, Klionsky BA. An unusual gastric bezoar in a newborn: Polystyrene resin and Candida albicans. J Pediatr 1983; 102:121-123. (Pubitemid 13167869)
64. Ohlsson A, Hosking M. Complications following oral administration of exchange resins in extremely low-birth-weight infants. Eur J Pediatr 1987; 146:571-574. (Pubitemid 18059462)
65. Koneru P, Kaufman RA, Talati AJ, Jenkins MB, Korones SB. Successful treatment of sodium polystyrene sulfonate bezoars with serial water-soluble contrast enemas. J Perinatol 2003; 23:431-433. (Pubitemid 36986801)
66. Algozzine GJ, Hill G, Scoggins WG, Marr MA. Sucralfate bezoar. N Engl J Med 1983; 309:1387. (Pubitemid 14246564)
67. Quigley MA, Flicker M, Caldwell EG. Sucralfate bezoar - theory or fact? Am J Gastroenterol 1986; 81:724-725.
68. Anderson W, Weatherstone G, Veal C. Esophageal medication bezoar in a patient receiving enteral feedings and sucralfate. Am J Gastroenterol 1989; 84:205-206. (Pubitemid 19060763)
69. Carrougher JG, Barrilleaux CN. Esophageal bezoars: The sucralith. Crit Care Med 1991; 19:837-839.
70. Krupp KB, Johns P, Troncoso V. Esophageal bezoar formation in a tube-fed patient receiving sucralfate and antacid therapy: A case report. Gastroenterol Nurs 1995; 18:46-48.
71. Hart RS, Levin B, Gholson CF. Esophageal obstruction caused by sucralfate impaction. Gastrointest Endosc 1989; 35:474-475. (Pubitemid 19266687)
72. Shueke M, Mihas AA. Esophageal bezoar due to sucralfate. Endoscopy 1991; 23:305-306.
73. Strozik KS, Walele AH, Hoffman H. Bezoar in a preterm baby associated with sucralfate. Clin Pediatr (Phila) 1996; 35:423-424. (Pubitemid 26334133)
74. Cereda JM, Scott J, Quigley EM. Endoscopic removal of pharmacobezoar of slow release theophylline. Br Med J (Clin Res Ed) 1986; 293:1143. (Pubitemid 16008921)
75. Smith WDF. Endoscopic removal of a pharmacobezoar of slow release theophylline. Br Med J (Clin Res Ed) 1987; 294:125.
76. Bernstein G, Jehle D, Bernaski E, et al. Failure of gastric emptying and charcoal administration in fatal sustained-release theophylline overdose: Pharmacobezoar formation. Ann Emerg Med 1992; 21:1388-1390.
77. Saeki S, Shimoda T, Sakai H, Soejima Y, Matsuse H, Kohno S. Successful treatment of theophylline toxicity by upper gastrointestinal endoscopy. Respir Med 2003; 97:734-735. (Pubitemid 36675679)
78. Djogovic D, Hudson D, Jacka M. Gastric bezoar following venlafaxine overdose. Clin Toxicol (Phila) 2007; 45:735. (Pubitemid 47394420)
79. Hudson D, Djogovic D. Alternate venlafaxine kinetics in overdose patients. J Clin Pharm Ther 2007; 32:109. (Pubitemid 46213947)
80. Jones JB, Moore JC, Setzer SC, Lintner CP, Roberts DJ. Massive venlafaxine ingestion resulting hypotension and pharmacobezoar formation, in 2009 North American Congress of Clinical Toxicology (NACCT). Clin Toxicol (Phila) 2009; 47:747. Abstracts.
81. Rankin RJ, Edwards IR. Overdose of sustained release verapamil. N Z Med J 1990; 103:165. (Pubitemid 20383263)
82. Buckley N, Dawson AH, Howarth D, Whyte IM. Slow-release verapamil poisoning. Use of polyethylene glycol whole-bowel lavage and high-dose calcium. Med J Aust 1993; 158:202-204. (Pubitemid 23094591)
83. Sporer KA, Manning JJ. Massive ingestion of sustained-release verapamil with a concretion and bowel infarction. Ann Emerg Med 1993; 22:603-605. (Pubitemid 23077205)
84. Robert R, Frat JP, Veinstein A, Rouffineau J. Protective effect of medication bezoar after a massive beta-blocker, digoxin, and amitriptyline poisoning. Clin Toxicol (Phila) 2005; 43:381-382. (Pubitemid 41428771)