EVIDENCE LIBRARY
A gastric tablet aggregate after lorazepam and slow-release clomipramine ingestion
A mixed-overdose case shows why a reported ingestion may not follow a simple absorption timeline.
A mixed-overdose case shows why a reported ingestion may not follow a simple absorption timeline.
What was directly observed
A woman was found unconscious after ingestion of slow-release clomipramine, lorazepam, and domperidone. Imaging showed multiple opaque gastric masses. After airway protection and activated charcoal, clinicians performed two endoscopic procedures twelve hours apart to remove a large tablet aggregate.
The authors considered the large tablet burden, sustained-release clomipramine formulation, and reduced gastrointestinal motility relevant to pharmacobezoar formation. Lorazepam was part of the reported exposure, but the paper did not establish that lorazepam tablets alone formed the aggregate.
What the case can support
A retained tablet mass can complicate assumptions about when material becomes available for absorption. The case does not quantify a separate lorazepam release curve or establish a universal delay for mixed overdoses. Its clinical course also involved several treatments rather than a controlled test of one decontamination method.
For forensic reconstruction, distinguish the reported swallowed amount, material retained in the stomach, analytical results, and observed clinical effects. A single concentration cannot reveal every part of that sequence. The report supports investigating unusual absorption conditions when actual case evidence points to them; it does not provide a general management protocol or justify extrapolating the clomipramine findings to every benzodiazepine exposure.
Source paper
Original analysis of the supplied journal article, identified as PMC6391823.