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Acetaminophen pharmacobezoar following a massive suicidal ingestion
Tom Steckler1, Adeline Blanchot1, Laurie Gheddar1
1Institut de médecine légale, Strasbourg, France.
Journal of Forensic Sciences
|August 13, 2025
Summary
A massive acetaminophen overdose formed a gastric pharmacobezoar, potentially causing delayed drug absorption and death. This case highlights an unusual complication of acetaminophen toxicity.
Area of Science:
- Forensic Pathology
- Clinical Toxicology
- Pharmacology
Background:
- A fatal case of massive acetaminophen (paracetamol) intoxication is presented.
- The patient, a 61-year-old woman, ingested a large quantity of acetaminophen capsules with suicidal intent.
Observation:
- A large gastric pharmacobezoar (10 × 9 × 7 cm) was discovered during forensic autopsy and postmortem CT.
- Acetaminophen is moderately water-soluble, making pharmacobezoar formation unusual.
- Simultaneous alcohol consumption and the excipient magnesium stearate may have contributed to bezoar formation.
Findings:
- Toxicological analysis revealed a high acetaminophen blood level (690 mg/L), indicative of delayed absorption due to the bezoar.
- The presence of the pharmacobezoar supports its role in the observed "double-hump" pharmacokinetic profile in massive overdoses.
- Histopathological analysis showed no liver necrosis, questioning acute liver failure as the cause of death.
Implications:
- Acetaminophen pharmacobezoars can significantly alter drug absorption kinetics in overdose cases.
- This case suggests alternative mechanisms of toxicity beyond acute liver failure in massive acetaminophen ingestions.
- Understanding pharmacobezoar formation is crucial for managing severe acetaminophen poisoning.
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