Nonketotic Hyperglycemic Coma in Toddlers After Unintentional Methadone Ingestion

Tiras, Sinan; Haas, Vincent; Chevret, L.; Decobert, Marion; Buisine, A.; Devictor, Denis; Durand, Philippe; Tissières, Pierre

doi:10.1016/j.annemergmed.2006.02.023

Cited by 32 publications

(18 citation statements)

References 27 publications

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“…13 For those patients who present in a coma, cardiorespiratory support with intubation, as well as maintenance of airway, pulse, and blood pressure is the proper initial management. 13,21,31 pathophysiology Narcotic-induced leukoencephalopathy cannot be explained by a purely hypoxic insult alone, as primary hypoxia preferentially damages gray matter structures, a pattern that was not seen in our case. 4,22 Furthermore, involvement of the corpus callosum argues against a purely hypoxic injury, as it is richly supplied with oxygen by plentiful perforating arterioles.…”

Section: Discussion Clinical Presentationsmentioning

confidence: 77%

Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications

Reisner

Hayes

Holland

et al. 2015

PED

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In environments in which opioids are increasingly abused for recreation, children are becoming more at risk for both accidental and nonaccidental intoxication. In toxic doses, opioids can cause potentially lethal acute leukoencephalopathy, which has a predilection for the cerebellum in young children. The authors present the case of a 2-year-old girl who suffered an accidental opioid overdose, presenting with altered mental status requiring cardiorespiratory support. She required emergency posterior fossa decompression, partial cerebellectomy, and CSF drainage due to cerebellar edema compressing the fourth ventricle. To the authors’ knowledge, this is the first report of surgical decompression used to treat cerebellar edema associated with opioid overdose in a child.

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Section: Discussion Clinical Presentationsmentioning

confidence: 77%

Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications

Reisner

Hayes

Holland

et al. 2015

PED

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“…Hyperglycemia was also more prominent in placebo group and even high levels up to 319 mg/dL, supposed to be related to diabetes, were detected in these patients. Ketotic or nonketotic hyperglycemic coma has already been attributed to MTD overdose and its related deaths [32, 33]. Therefore, high blood sugar may be an indicator of severe toxicity, a sign that was controlled in NLTX group.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Naltrexone in the Prevention of Delayed Respiratory Arrest in Opioid-Naive Methadone-Intoxicated Patients

Aghabiklooei¹,

Hassanian‐Moghaddam

Zamani

2013

BioMed Research International

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Acute methadone toxicity is a major public health concern in Iran. Methadone-intoxicated patients are in a great risk of recurrent or delayed respiratory arrest despite the prescription of initial doses of naloxone. This study aimed to evaluate the effectiveness of oral naltrexone in the management of acute methadone overdose in opioid-naive patients and check if it could be a substitute of continuous infusion of naloxone in maintaining adequate ventilation. In a randomized, double-blind, placebo-controlled study, a total of 54 opioid-naive patients with acute methadone toxicity were enrolled. The patients received either oral naltrexone or placebo capsules after awakening by naloxone. All patients underwent close monitoring of respiration. Frequency of respiratory depression or arrest, need for another dose of naloxone, duration of hospital stay, and adverse outcomes compared between the two groups. The incidence of respiratory depression was significantly less in those who had received naltrexone. Our results show that single oral dose of naltrexone is quite efficient in the prevention of recurrent or delayed respiratory arrest in opioid-naive methadone-intoxicated patients. It can shorten the duration of hospitalization and, as a consequence, decreased the risk of complications. Further studies are warranted before the generalization of this approach to other patient populations.

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“…1 However, this is also a global problem. 2,3 Death or severe poisonings of children caused by accidental intake or intentional administration were reported for heroin, 4,5 methadone, [6][7][8][9][10][11][12][13][14][15] cocaine, [16][17][18][19][20] and ecstasy. 21 Between them, the number of death cases with methadone is particularly high and has caught attention since the introduction of this drug as an opioid analgesic in 1947 and for opiate withdrawal therapy in the 1960s.…”

Section: Introductionmentioning

confidence: 99%

Methadone and Illegal Drugs in Hair From Children With Parents in Maintenance Treatment or Suspected for Drug Abuse in a German Community

Pragst

Broecker

Hastedt

et al. 2013

Therapeutic Drug Monitoring

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Nonketotic Hyperglycemic Coma in Toddlers After Unintentional Methadone Ingestion

Cited by 32 publications

References 27 publications

Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications

Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications

Effectiveness of Naltrexone in the Prevention of Delayed Respiratory Arrest in Opioid-Naive Methadone-Intoxicated Patients

Methadone and Illegal Drugs in Hair From Children With Parents in Maintenance Treatment or Suspected for Drug Abuse in a German Community

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