@article{3108174,
    title = "Methadone gastrobezoar in a psychiatric patient presented in coma",
    author = "Gavala, A. and Manou, D. and Psalida, V. and Nystatzaki, M. and Mavrogiannis, C. and Alevizopoulos, G. and Myrianthefs, P.",
    journal = "Indian Journal of Critical Care Medicine",
    year = "2017",
    volume = "21",
    number = "11",
    pages = "796-798",
    publisher = "Wolters Kluwer--Medknow Publications",
    issn = "0972-5229",
    doi = "10.4103/ijccm.IJCCM_17_17",
    keywords = "activated carbon;  alprazolam;  erythromycin;  flumazenil;  fondaparinux;  lactulose;  meglumine diatrizoate;  methadone;  metoclopramide;  naloxone;  olanzapine;  omeprazole;  quetiapine;  sultamicillin, abdominal radiography;  abnormal laboratory result;  adult;  Article;  bezoar;  case report;  clinical article;  coma;  computer assisted tomography;  deep vein thrombosis;  depression;  drug dependence;  gastroscopy;  human;  hypercapnia;  intensive care unit;  intubation;  male;  mental patient;  neuroimaging;  respiratory failure;  schizophrenia;  stomach erosion;  stomach juice;  stomach lavage;  stress ulcer;  suicide attempt;  tablet;  toxicology;  treatment response",
    abstract = "A 43-year-old psychiatric patient was transferred in coma and hypercapnic respiratory failure at the emergency department. He was intubated for airway protection and transferred to the Intensive Care Unit (ICU). Abdominal X-ray revealed a radiopaque mass; a pharmacobezoar was suspected and confirmed by gastroscopy; one large in the stomach fundus and a smaller one in the pylorus. Gastric lavage through the gastroscope and administration of gastro-kinetic drugs and laxatives were able to dilute the bezoars. Tablets retrieved from the stomach identified as methadone and toxicological tests of the gastric fluid confirmed the presence of methadone as the only organic chemical compound. The patient was extubated on the 7th day and released from the ICU on the 10th day under psychiatric consultation having normal vital signs. Methadone gastric bezoar may lead to persistent intoxication, respiratory failure, and coma requiring ICU care. Diagnosis may be difficult and a high index of suspicion is needed. © 2017 Indian Journal of Critical Care Medicine | Published by Wolters Kluwer - Medknow."
}