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Adolescent with prolonged toxidrome
Jami Johnson1, Kristie Williams1, William Banner1,2
1a Oklahoma Center for Poison and Drug Information, University of Oklahoma College of Pharmacy , Oklahoma City , OK , USA.
Clinical Toxicology (Philadelphia, Pa.)
|April 20, 2017
Summary
A rare case of a pharmacobezoar, a medication bezoar, formed from diphenhydramine ingestion caused prolonged toxicity. Successful removal of the pharmacobezoar led to full patient recovery.
Area of Science:
- Toxicology
- Gastroenterology
- Emergency Medicine
Background:
- Intentional drug ingestion can lead to severe toxicity, posing diagnostic and management challenges.
- Prolonged, unexplained symptoms after ingestion warrant consideration of unusual complications.
- Pharmacobezoars, while rare, represent a significant cause of persistent toxicity.
Observation:
- A 13-year-old female presented with persistent seizures and toxicity after intentional diphenhydramine ingestion.
- Radiographic imaging revealed a radiopaque mass consistent with a pharmacobezoar.
- Endoscopic intervention successfully removed a large pharmacobezoar.
Findings:
- Diphenhydramine, not previously known to form pharmacobezoars or be radiopaque, was implicated in this case.
- The pharmacobezoar was a tennis ball-sized mass.
- Symptom resolution occurred promptly after pharmacobezoar removal.
Implications:
- This case highlights the potential for pharmacobezoar formation from diphenhydramine, expanding known causative agents.
- Toxicologists and emergency physicians should consider pharmacobezoars in cases of prolonged toxicity unresponsive to standard treatment.
- Radiopaque pharmacobezoars can be identified via abdominal radiography, aiding in diagnosis.
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