An endoscopic end to coma

ABSTRACTA 23-year-old man presented to the emergency department after ingesting an unknown amount of an immediate-release preparation of carbamazepine. Thirty minutes after presentation, he became obtunded and required intubation for airway protection. Initial serum carbamazepine concentration was 59 μg/mL and peaked at 120 μg/mL 16 hours later. High-flux hemodialysis (HFHD) was performed, followed by continuous venovenous hemodiafiltration (CVVH). The patient remained comatose as his hospital course was remarkable for prolonged serum carbamazepine toxicity. On day 12, esophagogastroduodenoscopy (EGD) was performed and a 5 cm carbamazepine bezoar weighing 9.9 g was recovered from his stomach using an esophageal overtube and a Roth Net to facilitate extraction. Following endoscopic intervention, serum carbamazepine concentrations rapidly declined and his mental status improved with no permanent neurological deficit or other sequelae.