A Case of Relapse into Deep Coma Following Repeated Doses of Activated Charcoal Administered in Response to an Overdose of Vegetamin B (A Combination of Phenobarbital, Chlorpromazine, and Promethazine)

DOI 7 References
  • Furuya Ryosuke
    Department of Critical Care and Emergency Medicine, Showa General Hospital
  • Okada Yasusei
    Department of Critical Care and Emergency Medicine, Showa General Hospital
  • Inagawa Hiroshi
    Department of Critical Care and Emergency Medicine, Showa General Hospital
  • Kojima Naoki
    Department of Critical Care and Emergency Medicine, Showa General Hospital
  • Ishida Jyunrou
    Department of Critical Care and Emergency Medicine, Showa General Hospital
  • Sasaki Nobuo
    Department of Critical Care and Emergency Medicine, Showa General Hospital
  • Yoshimura Yukihiro
    Department of Critical Care and Emergency Medicine, Showa General Hospital

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  • 活性炭の反復投与後に意識障害が再燃したベゲタミン中毒の１症例

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A 31-year-old man was admitted to our hospital in a state of intoxication with a Phenobarbital-Chlorpromazine-Promethazine combination (Vegetamin B®). On arrival at the hospital, the man was in a deep coma. After transfer to intensive care unit, his spontaneous breathing had stopped and his brainstem reflex was absent. Toxicology studies showed serum concentrations of Phenobarbital at 122.8μg/ml. Chest and abdominal X rays showed gastric mass formation. We began gastric lavage, administration of multiple-dose activated charcoal, and charcoal hemoperfusion. After 3 rounds of hemoperfusion, the man temporarily regained consciousness and the serum concentrations decreased to 22.5μg/ml. But 12 hours later, he relapsed into coma and the serum concentrations increased again, to 101.2μg/ml. We judged this to be caused by a “charcoal-drug mass” in the ascending-transverse colon, which showed on an abdominal X ray. We restarted charcoal hemoperfusion, together with whole bowel irrigation. The serum concentrations of Phenobarbital decreased gradually, and the man made a gradual recovery and was discharged from the hospital 3 weeks after admission. We recommend that administration of multiple-dose activated charcoal for a life-threatening amount of Vegetamin® overdose patients be accompanied by co-administration of a cathartic and that administration should be discontinued and treated with whole bowel irrigation if the charcoal does not appear in the stools within 12 hours, not only to decrease the risk of bowel obstruction but also to hasten the elimination of “charcoal-drug complex”.

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