A case of unexplained duodenal ulcer and massive gastrointestinal bleed.
Journal
Clinica chimica acta; international journal of clinical chemistry
ISSN: 1873-3492
Titre abrégé: Clin Chim Acta
Pays: Netherlands
ID NLM: 1302422
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
29
02
2020
revised:
25
03
2020
accepted:
25
03
2020
pubmed:
3
4
2020
medline:
26
1
2021
entrez:
3
4
2020
Statut:
ppublish
Résumé
A 73-year-old man was displaying symptoms of massive gastrointestinal (GI) bleed. Surgical actions were performed to control the bleed caused by an erosive duodenal ulcer with duodenal perforation. When investigating the culprit of this case, the pain medications prescribed two weeks prior by a traditional Chinese medicine doctor raised attention. The patient's admission serum sample and the pain medications from unknown sources were analyzed using a clinically validated liquid chromatography-high-resolution mass spectrometry (LC-HRMS) method. The NSAIDs diclofenac, piroxicam, and indomethacin were identified, as well as some other synthetic drugs and natural products. The patient's concurrent exposure to multiple NSAIDs significantly increased the risk of upper GI complications. It is reasonable to argue that the high-dose use of the NSAIDs was a major cause of the duodenal ulcer and GI bleed. In addition, the identified natural products such as atropine and ephedrine have well-documented toxicities. It is important to increase the visibility of unregulated medications, and the capability to perform untargeted mass spectrometry analysis provides a unique diagnostic advantage in cases where exposure to toxic substances is possible.
Identifiants
pubmed: 32234495
pii: S0009-8981(20)30139-X
doi: 10.1016/j.cca.2020.03.037
pmc: PMC9055633
mid: NIHMS1801121
pii:
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
188-190Subventions
Organisme : NIGMS NIH HHS
ID : K23 GM130892
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
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