Clinical Images in Medical Toxicology: Heroin Overdose with Non-Cardiogenic Pulmonary Edema

Mell, Howard K.; Sztajnkrycer, Matthew D.

doi:10.1080/15563650600671803

Cited by 5 publications

(7 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Non-cardiogenic pulmonary edema (NCPE) has been associated with multiple opioids, including heroin, methadone, morphine, and propoxyphene [46]. This was first described by Osler in 1880 from heroin use [1].…”

Section: Pulmonary Edemamentioning

confidence: 99%

“…The incidence of NCPE in patients hospitalized for heroin overdose is estimated to be around 3 % [46]. Characteristics that have been associated with increased risk of NCPE include male sex, short duration of heroin use (mean, 2.9 years), being found obtunded (GCS<8), and requiring naloxone in the pre-hospital setting [46]. Up to 50 % of the time, there is co-intoxication with ethanol or cocaine [47].…”

Section: Pulmonary Edemamentioning

confidence: 99%

See 1 more Smart Citation

The Effects of Opioids on the Lung

Radke

Owen

Sutter

et al. 2013

Clinic Rev Allerg Immunol

View full text Add to dashboard Cite

The term opioid refers to a broad class of medications that are used most frequently for their analgesic effects. Along with this effect, they also produce euphoria, and it is for this reason that they have been used illicitly, as well as medicinally, for thousands of years. While the most well-known complications of opioid use and misuse include respiratory and central nervous system depression, there are many other toxicities that have been associated with these drugs. Many complications can occur with multiple different opioids, such as non-cardiogenic pulmonary edema, while many of the complications are unique to the opioid used as well as the route of administration. This review focuses on the pulmonary complications associated with opioid use and abuse, but opioids can affect nearly every organ system. Their effects on the pulmonary system can be direct, such as causing granulomatous change, but they can also work indirectly. For example, opioids cause respiratory depression by decreasing sensitivity of peripheral chemoreceptors to carbon dioxide and decreasing activity in the central respiratory centers. Opioids have also been reported to affect the immune system, and place users at increased risk for many different infectious complications. Patients can have a wide array of signs and symptoms, sometimes making it difficult to recognize opioids as a cause for a patient's clinical picture. Due to the sedative effects of opioids, patients are also often not able to provide a reliable history. Knowledge of the possible toxicities of opioids can help prepare a physician to recognize the many complications associated with opioid use.

show abstract

Section: Pulmonary Edemamentioning

confidence: 99%

Section: Pulmonary Edemamentioning

confidence: 99%

The Effects of Opioids on the Lung

Radke

Owen

Sutter

et al. 2013

Clinic Rev Allerg Immunol

View full text Add to dashboard Cite

show abstract

“…Alternatively, heroin-induced respiratory depression and the subsequent hypoxia-induced increased vascular permeability, morphine-induced anaphylactoid reactions, or attempted inspiration against a closed glottis may also be possible causes. 118,119 This may be more apparent after the patient starts breathing again after reversal with naloxone. 119 Methylenedioxymethamphetamine is a synthetic amphetamine derivative, which releases endogenous catecholamines, which can cause a sympathetic surge and NCPE development similar to NPE.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Naloxone may cause a type of withdrawal syndrome, which is known to cause a sympathetic surge similar to that seen in NPE, and this may explain the development of NCPE. Alternatively, heroin‐induced respiratory depression and the subsequent hypoxia‐induced increased vascular permeability, morphine‐induced anaphylactoid reactions, or attempted inspiration against a closed glottis may also be possible causes 118,119 . This may be more apparent after the patient starts breathing again after reversal with naloxone 119 .…”

Section: Drug Induced Ncpementioning

confidence: 99%

See 1 more Smart Citation

Noncardiogenic pulmonary edema in small animals

Unger

Martin

2023

J Vet Emergen Crit Care

View full text Add to dashboard Cite

Objective To review various types of noncardiogenic pulmonary edema (NCPE) in cats and dogs. Etiology NCPE is an abnormal fluid accumulation in the lung interstitium or alveoli that is not caused by cardiogenic causes or fluid overload. It can be due to changes in vascular permeability, hydrostatic pressure in the pulmonary vasculature, or a combination thereof. Possible causes include inflammatory states within the lung or in remote tissues (acute respiratory distress syndrome [ARDS]), airway obstruction (post‐obstructive pulmonary edema), neurologic disease such as head trauma or seizures (neurogenic pulmonary edema), electrocution, after re‐expansion of a collapsed lung or after drowning. Diagnosis Diagnosis of NCPE is generally based on history, physical examination, and diagnostic imaging. Radiographic findings suggestive of NCPE are interstitial to alveolar pulmonary opacities in the absence of signs of left‐sided congestive heart failure or fluid overload such as cardiomegaly or congested pulmonary veins. Computed tomography and edema fluid analysis may aid in the diagnosis, while some forms of NCPE require additional findings to reach a diagnosis. Therapy The goal of therapy for all types of NCPE is to preserve tissue oxygenation and reduce the work of breathing. This may be achieved by removing the inciting cause (eg, airway obstruction) and cage rest in mild cases and supplemental oxygen in moderate cases and may require mechanical ventilation in severe cases. Prognosis Prognosis is generally good for most causes of veterinary NCPE except for ARDS, although data are scarce for some etiologies of NCPE.

show abstract

Respiratory Problems and Substance Misuse

Nanayakkara

McNamara

2020

Textbook of Addiction Treatment

View full text Add to dashboard Cite

Clinical Images in Medical Toxicology: Heroin Overdose with Non-Cardiogenic Pulmonary Edema

Cited by 5 publications

References 3 publications

The Effects of Opioids on the Lung

The Effects of Opioids on the Lung

Noncardiogenic pulmonary edema in small animals

Respiratory Problems and Substance Misuse

Contact Info

Product

Resources

About