An unexpected prolonged coma due to a pharmacobezoar formed from V egetamine A ® tablet ingestion

Abstract

Case: A 49-year-old man ingested massive quantities of Vegetamine A® tablets that contain two anticholinergic agents in addition to phenobarbital. The patient remained in an unexpectedly prolonged coma 4 days post-hospitalization. An acute gastroscopy revealed a pinkish-white pharmacobezoar on the lesser curvature of the stomach, which was extracted using a net. Direct hemoperfusion and treatment with multiple-dose activated charcoal was then initiated. Phenobarbital serum concentrations eventually decreased, resulting in complete recovery of the patient. Outcome: On day 30, the patient was transferred to the Psychiatric Department. Conclusion: An intragastric pharmacobezoar should be suspected in patients with promoted and prolonged toxicity or if high serum concentrations of agents indicate their continuous absorption.