Opioid Overdose and Serotonin Syndrome due to Gastric Bezoar in a Woman with Autism and Pica Behaviour

Iolanda Palimaru,David Cohen,Marianna Giannitelli,Cora Cravero,Clémence Fron,Michaël Guetta

doi:10.1155/2021/7334467

Abstract

We are presenting the case of a 38-year-old woman with nonverbal autism and intellectual disability, hospitalized in a neurobehavioural unit because of a pica behaviour for 3 years. During the hospitalization, the patient presented an episode of pain, agitation, restlessness, rhabdomyolysis, coma, tachycardia, hyperthermia, shivering, and diarrhoea. The main hypothesis raised was tramadol overdose because of the immediate antidote response to the injection of naloxone 0,4 mg/mL. Even if we did not exceed the recommended prescription dosage of tramadol, the presence of gastric bezoar slowed the absorption of the drug, and the consequence was an opioid overdose and serotonin syndrome.

Highlights

Bezoars represent an accumulation of foreign bodies in the gastrointestinal tract
We are presenting the case of a 38-year-old woman with nonverbal autism, epilepsy, and severe ID, who was hospitalized in the neurobehavioural unit of the Pitié-Salpêtrière Hospital because of the installation of a severe pica behaviour for three years
Our patient underwent gastroduodenal fibroscopy under general anaesthesia which showed a gastric bezoar with multiple plastic foreign bodies, especially straws, medical compresses, and gloves (Figure 1)

Summary

Introduction

Bezoars represent an accumulation of foreign bodies in the gastrointestinal tract. They are most commonly localised in the stomach [1] and could be the consequence of pica behaviour. Pica can be encountered in several contexts of iron deficiency anemia, pregnancy, psychiatric conditions (e.g., depression, anxiety including trichotillomania, intellectual disability (ID), and autism spectrum disorder (ASD)) and more rarely in postbariatric surgery patients [2, 3]. In patients for whom symptoms suggest a lack of dosage or drug plasma levels exceeding known or expected pharmacokinetics principles, the presence of a foreign mass like a bezoar inside the gastrointestinal tract should be considered. A bezoar could temporarily block the absorption of a drug followed by a subsequent overdose [12]

Case Presentation

Discussion

Conflicts of Interest