Limb Compression and Renal Impairment (Crush Syndrome) Following Narcotic and Sedative Overdose

Schreiber, Saul N.; Liebowitz, Martin R.; Bernstein, Leslie H.

doi:10.2106/00004623-197254080-00008

Cited by 37 publications

(8 citation statements)

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“…96,[98][99][100] While it is a condition most commonly associated with "crush injuries" (when a limb is compressed as a result of trauma), it has been described in heroin users as occurring as a result of limb compression by another part of the body while comatose. 99,[101][102][103] In extreme cases rhabdomyolysis may lead to compartment syndrome, 104 where oedema raises intracompartmental pressure to such a degree that circulation is cut off to the rest of the limb. The treatment for such injuries is fasciotomy (the excision of the brous tissue dividing muscle compartments) to reduce pressure, and dialysis to compensate for impaired renal function.…”

Section: Muscular Effectsmentioning

confidence: 99%

“…While prognosis following treatment is generally good, 105 with most patients surviving and recovering renal function, permanent muscular impairment is common. 102,103 Neurological effects While neither heroin nor any of the other opiates are directly neurotoxic, overdose has the potential to cause signi cant neurological damage through prolonged hypoxia.…”

Section: Muscular Effectsmentioning

confidence: 99%

See 1 more Smart Citation

Heroin overdose: causes and consequences

et al. 2001

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Over the past decade fatal opioid overdose has emerged as a major public health issue internationally. This paper examines the risk factors for overdose from a biomedical perspective. While significant risk factors for opioid overdose fatality are well recognized, the mechanism of fatal overdose remains unclear. Losses of tolerance and concomitant use of alcohol and other CNS depressants clearly play a major role in fatality; however, such risk factors do not account for the strong age and gender patterns observed consistently among victims of overdose. There is evidence that systemic disease may be more prevalent in users at greatest risk of overdose. We hypothesize that pulmonary and hepatic dysfunction resulting from such disease may increase susceptibility to both fatal and non-fatal overdose. Sequelae of non-fatal overdose are recognized in the clinical literature but few epidemiological data exist describing the burden of morbidity arising from such sequelae. The potential for overdose to cause persisting morbidity is reviewed.

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Section: Muscular Effectsmentioning

confidence: 99%

Section: Muscular Effectsmentioning

confidence: 99%

Heroin overdose: causes and consequences

et al. 2001

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“…21 Cellular injury to muscle often results in myoglobinuria, potentially resulting in renal injury. 33 Neural deficits precede the onset of myoneural necrosis by a few hours. This fortunately allows a time window for diagnosis on the basis of neurological findings.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Small fascial defects associated with foot trauma may not be sufficient to significantly alter compartment volume. 21,28,33 Despite the potential for confusion with massive foot trauma, pain in the presence of compartment syndrome is usually out of proportion to injury, and will not abate with adequate immobilization of the injured foot. 21 to relieve pain following extremity trauma.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Review: Acute Compartment Syndrome of the Foot

2003

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Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. The purpose of this article is to summarize and review the existing literature on this entity. Long-term sequelae of foot compartment syndrome (FCS) include contractures, deformity, weakness, paralysis, and sensory neuropathy. These complications are poorly tolerated, and often necessitate multiple procedures for rehabilitation. Therefore, the threshold for considering compartment syndrome and performing fasciotomy must be low to minimize such outcomes. The existence of nine foot compartments and frequent presence of complicating injuries necessitate multi-stick needle catheterization for direct measurement of compartment pressures. Fasciotomy is indicated when compartment pressure exceeds 30 mmHg, or if compartment pressure is greater than 10-30 mmHg below diastolic pressure. The approaches for compartment decompression generally include two dorsal incisions for access to forefoot compartments, and one medial incision for decompression of the calcaneal, medial, superficial, and lateral compartments.

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“…1 In the last decade there have been several reports of crush injury and syndrome precipitated by prolonged compression of one or more limbs by the patient's own body weight following drug overdose. [2][3][4][5] The severity of the injury is dictated by the duration of compression, amount of force applied and the pressure created. The injury causes ischaemia together with damage to nerve and muscle tissue.…”

Section: Discussionmentioning

confidence: 99%