Methadone overdose is expected to result in intoxication simulating the other opioids. We report a case of hypoglycaemia following accidental methadone ingestion. A 21-year-old woman presented to a local accident and emergency department 10 hours after ingestion of 800 mg of methadone. She was found to have coma, respiratory suppression, hypotension, prolonged QTc and hypoglycaemia. The hypoglycaemia was reversed by dextrose replacement. The patient required intubation and inotropic support because of cardio-respiratory instability. She eventually recovered without consequence. To date, this is the first reported case of methadone overdose induced hypoglycaemia.

C M E disease. Predictors of severe RSV infection in patients with heart disease were heart failure, pulmonary hypertension, and severe airway abnormalities associated with congenital heart disease. Conclusions: Respiratory syncytial virus infection occurs mainly in spring and summer in Hong Kong, and is related to meteorological conditions. Respiratory syncytial virus infection poses a heavy disease burden on children with heart disease. A local guideline on RSV immunoprophylaxis for these children is therefore needed. This article was published on 9 Oct 2019 at www.hkmj.org. New knowledge added by this study • This study reviewed the epidemiology and impact of respiratory syncytial virus (RSV) infection on children with heart disease (HD) in Hong Kong. • RSV infections are common in Hong Kong, and the incidence peaks from March to August; prevalence is greatest in children aged <1 year, and there is a mild male preponderance. Infection is favoured by high relative humidity, low wind speed, and low atmospheric pressure. • HD, both congenital and acquired, is a distinct risk factor for severe RSV infection in terms of hospital length of stay, reinfection, complication, respiratory failure, and the requirements for intensive care unit care and mechanical ventilation. Implications for clinical practice or policy • A local guideline on RSV immunoprophylaxis is needed for children with HD. • In Hong Kong, an RSV immunoprophylaxis scheme administered monthly for 5 months, beginning in the first year of life, should be considered in children with HD who exhibit any of the following severity predictors: heart failure, pulmonary hypertension, and severe airway abnormalities associated with congenital HD. • The optimal timing for immunoprophylaxis may be during the local peak of infection, from March to August.

Non-accidental poisoning with carbon monoxide appears to be a new means of child abuse with potentially serious consequences. Concomitant intoxication with psychotropic drugs is common in such cases. The reason for parents killing their own children under such circumstances was unclear, but a desire to exact revenge on an estranged partner was suggested.

Hydroxychloroquine overdose is a rare condition and often results in severe cardiovascular toxicities. We report 2 cases of fatal hydroxychloroquine overdose (1 patient had co-ingestion of chloroquine). Both patients developed refractory cardiovascular collapse and cardiac arrest soon after the drug overdose. Both of them were treated with high dose adrenaline and diazepam. However, they deteriorated rapidly despite the treatments. In view of similar toxicological profile of hydroxychloroquine to other lipophilic cardiotoxic medications, intravenous lipid emulsion was given as the last resort but both of them died eventually. Based on the clinical experience from these 2 cases, Intravenous lipid emulsion is not effective in reversing the cardiotoxic effects of hydroxychloroquine and chloroquine overdose.

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