Faculty of Medicine

Permanent URI for this communityhttps://repository.ukim.mk/handle/20.500.12188/14

Browse

Settings

Has files: YesSubject: search.filters.subject.methadone

Search Results

Now showing 1 - 2 of 2
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    Opioid overdose or other somatic comorbidity - fatal case
    (Македонско лекарско друштво = Macedonian medical association/De Gruyter, 2024-04)
    ;
    Bekjarovski, Niko
    ;
    ;
    ;
    The aim of this case presentation is to emphasize the diagnostic challenges that the clinicians encounter when dealing with a comatose patient and the importance of keeping a broad differential diagnostic panel in mind. Case report: A 47-year-old female patient, was brought by ambulance to the University Clinic for Toxicology in Skopje. On admission, she was comatose (GCS=5), with miotic isochoric pupils, blood pressure was 90/60 mmHg, with oxygen saturation from 85 up to 92%. Тhe obtained data from family indicated that the patient was with opioid use disorder on methadone maintenance therapy. Recently, the patient has consumed large amounts of alcohol . Тhe family's suspicion was that perhaps the new condition was caused by excessive intake of alcohol or methadone or both. In the meantime, the result of alcoholemia showed 67.0 mg/dL (value <100mg/dLlow level) and the toxicological screening in urine sample for tetrahydrocannabinol, opiates, tramadol, amphetamine, 3,4-methylenedioxy-methamphetamine, cocaine, benzodiazepines, buprenorphine was negative with mildly elevated methadone values (the patient was on methadone substitute the last 7 years). Second day on physical examination a brisk response to deep tendon reflexes of the left side of the body with apparent right hemiplegia was noted. Computed tomography of the brain was performed immediately and showed an ischemic stroke with a compressive effect on the left lateral chamber. Although it was immediately started with an aggressive treatment, after 11 days the condition of the patient deteriorated and resulted in death. Conclusion: The notable opioid prevalence, mandates that physicians maintain a high index of suspicion when dealing with a comatose patient, especially if the patient has any known history of opioid abuse. Healthcare professionals should be aware that a comatose state in a patient could be caused by either non-toxicological trigger or by toxic causes.
  • Loading...
    Thumbnail Image
    Some of the metrics are blocked by your 
    consent settings
    Item type:Publication,
    QT PROLONGATION AND VENTRICULAR ARRHYTHMIA IN METHADONE USER PRESENTING WITH SEVERE HYPOKALEMIA
    (Institute of Knowledge Management, 2022-12-16)
    ;
    Mario Jovanoski
    ;
    ;
    Elena Grueva Nastevska
    ;
    Hajber Taravari
    Introduction: Severe hypokalemia is a serious, life-threatening condition that can lead to muscle weakness, paralysis, fatigue and different types of cardiac rhythm disturbances including QT prolongation and furthermore lethal arrhythmias. On the other hand, prolongation of the QT interval can be exacerbated in methadone users who receive high doses of the drug. Methadone is a drug that is mostly used as a replacement therapy for opiates, and it is known that it can interfere in the cardiac action potential cycle. Case report: We present a case of 39y/old male who visited our clinic brought by an ambulance due to palpitations, fatigue and muscle weakness in the arms and legs. The patients’ symptoms aggravated in the past 2 weeks when he lost the ability to do the everyday activities and finally to walk, because of extreme weakness of the extremities. On the day of the admission, he experienced a syncope for the first time in his life. His initial ECG revealed sinus rhythm with prolonged QT interval and polymorphic ventricular extrasystoles, which evolved in nonsustained ventricular tachycardia. His initial laboratory finding showed severe hypokalemia, and his previous medical history revealed use of methadone replacement therapy for approximately 20 years. The patient was closely monitored in the intensive care unit, and potassium replacement therapy was immediately initiated by the use of intravenous potassium infusion. Toxicologist and nephrologist were also included in the treatment in order to reduce the methadone dose and to exclude a secondary cause of severe hypokalemia. The patient’s condition improved after 9 days, when the potassium level was in normal range and the rhythm disturbances completely resolved. Conclusion: This case highlights the importance of timely recognition of severe electrolytic abnormalities that can lead to dangerous arrhythmias. Careful replacement with 24h monitoring and frequent laboratory analysis is required until the potassium level reaches the target range and until the heart rhythm stabilizes. This case also reveals the importance of the significance of the follow up of every drug addict that receives methadone replacement therapy on a primary level, in order to exclude QT prolongation. In these cases, the dose of methadone should be reduced or replaced with another medication, in order to prevent potentially lethal arrhythmias.