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Forensic Sci Int ; 229(1-3): e19-22, 2013 Jun 10.
Article in English | MEDLINE | ID: mdl-23570967

ABSTRACT

The paper presents a case of fatal intoxication after massive sustained-release clomipramine overdosage with prolonged toxicity related to a large gastric pharmacobezoar. 42-year-old female was admitted to the toxicology unit 14 h after drugs ingestion. At admission patient was deeply unconscious, required controlled mechanical ventilation. Serum total level of TCAs was 1955 ng/mL. Gastric lavage revealed no pills. Within the next 12h the patient's clinical condition improved. TCAs level decreased to 999 ng/mL. However, after another 10h the clinical condition started deteriorating again and the patient went into a deep coma requiring controlled mechanical ventilation. TCAs level increased to 2011 ng/mL. X-ray and computed tomography revealed large pharmacobezoar consisted from radio-opaque pills. In the 28th h of hospitalization gastrotomy was performed, confirming presence of pharmacobezoar formed from Anafranil SR tablets. After surgery TCAs level was gradually decreasing. However, the patient's condition did not improve, she died 32 h after gastrotomy. Post-mortem analyses revealed drug and its metabolite toxic levels in blood (clomipramine - 1729 ng/mL, norclomipramine - 431 ng/mL) and toxic levels in internal organs: myocardium (clomipramine - 14,420 ng/g, norclomipramine - 35,930 ng/g), vitreous humor (clomipramine - 1000 ng/mL, norclomipramine - 3110 ng/mL). Described case report indicates that sustained release clomipramine tablets may form pharmacobezoar. X-ray and computed tomography examinations should be considered in cases of massive abuse of sustained release clomipramine, particularly if symptoms of intoxication are recurrent or persistent.


Subject(s)
Antidepressive Agents, Tricyclic/poisoning , Bezoars/chemically induced , Clomipramine/poisoning , Drug Overdose , Stomach/pathology , Suicide , Adult , Antidepressive Agents, Tricyclic/analysis , Bezoars/pathology , Clomipramine/analysis , Delayed-Action Preparations , Doxepin/analysis , Doxepin/poisoning , Female , Forensic Pathology , Forensic Toxicology , Humans , Multiple Organ Failure/chemically induced , Myocardium/chemistry , Tomography, X-Ray Computed , Vitreous Body/chemistry
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