Gastro-esophageal pharmacobezoar

Area of Science:

• Forensic Pathology
• Clinical Toxicology
• Pharmacology

Background:

• Schizophrenia patients may experience adverse drug events.
• Propranolol overdose can be life-threatening.

Observation:

• A 35-year-old male with schizophrenia died from propranolol toxicity.
• Post-mortem CT revealed a large esophageal and gastric pharmacobezoar.
• The pharmacobezoar contained significant amounts of propranolol.

Findings:

• Autopsy identified 62g esophageal and 130g gastric pharmacobezoars.
• The pharmacobezoar's color originated from green propranolol tablets.
• No mechanical airway obstruction was evident; death resulted from drug elution.
• Lethal blood propranolol levels (60 mg/L) were detected.

Implications:

• Pharmacobezoars can cause fatal drug toxicity through slow release.
• This case highlights the importance of considering pharmacobezoars in overdose investigations.
• Understanding drug formulation and patient factors is crucial in managing toxicity.