Favorable Outcome of Severe Acute Methadone Poisoning (Clinical Case)
https://doi.org/10.15360/1813-9779-2018-5-25-31
Abstract
Purpose: to contribute to relief of metabolic disorders associated with hypoxia by including a succinate correcting tissue metabolism into the scheme of intensive care of acute severe methadone poisoning complicated by the crush syndrome.
Materials and methods. We examined the dynamics of clinical manifestation of acute methadone poisoning complicated by crush syndrome: changes in clinical and biochemical parameters, coagulation test findings, blood gas composition and acid-base state, ECG and X-ray findings.
Results. By the 7th day after patient's admission in the ICU, stabilization of hemodynamics, recovery of spontaneous breathing and consciousness, reduction of swelling and the beginning of the formation of pressure ulcers were observed; on the 8 the day, restoration of urination and characteristics of urine were registered. On the 12th day, the patient was transferred to the toxicology unit being in a state of moderate severity and demonstrating positive changes in all clinical parameters.
Conclusion. The inclusion of a drug with antioxidant/antihypoxant properties in the infusion therapy scheme allows to relieve metabolic disorders associated with hypoxia, and thereby increase the effectiveness of treatment: i.e. to relief clinical and laboratory manifestations and reduce the ICU stay.About the Authors
G. A. LivanovRussian Federation
Georgy A. Livanov
3 Budapeshtskaya Str., 192242 Saint-Petersburg
A. N. Lodyagin
Russian Federation
Alexey N. Lodyagin
3 Budapeshtskaya Str., 192242 Saint-Petersburg
A. А. Razina
Russian Federation
Anna A. Razina
47 Piskarevskii prospect, 195067 St. Petersburg
S. I. Glushkov
Russian Federation
Sergey I. Glushkov
3 Budapeshtskaya Str., 192242 Saint-Petersburg
A. A. Ivanova
Russian Federation
Alexandra A. Ivanova
47 Piskarevskii prospect, 195067 St. Petersburg
E. V. Volchkova
Russian Federation
Elizabeth V. Volchkova
6–8 Lev Tolstoy Str., 197022 St. Petersburg
B. V. Batotsyrenov
Russian Federation
Bair V. Batotsyrenov
3 Budapeshtskaya Str., 192242 Saint-Petersburg
References
1. Kuznetsov B.V., Lodyagin A.N., Batotsyrenov B.V., Nezhentseva I.V., Baranov D.V. Features of clinical course of acute methadone poisoning, complicated with acute compartment syndrome and systemic rhabdomyolysis. Toksikologichesky Vestnik. 2015; 4: 38-43. [In Russ.]
2. Blackburn D.J., Alix J.J., Sarrigiannis P., Hoggard N., Bandmann O. Delayed toxic-hypoxic encephalopathy. Pract. Neurol. 2013; 13 (2): 114119. DOI: 10.1136/practneurol-2012-000402. PMID: 23468562
3. Livanov G.A., Loladze A.T., Batotsyrenov B.V., Lodyagin A.N., Glushkov S.I., Kharitonova T.V., Ivanova A.A., Baranov D.V., Antonova A.M. Acute poisoning with methadone (dolphin) (review). Obshchaya Reanimatologiya = General Reanimatology. 2017; 13 (3): 48-63. DOI: 10.15360/1813-9779-2017-3-48-63. [In Russ., In Engl.]
4. Alinejad S., Ghaemi K., Abdollahi M., Mehrpour O. Nephrotoxicity of methadone: a systematic review. Springerplus. 2016; 5 (1): 2087. DOI: 10.1186/s40064-016-3757-1. PMID: 28018795
5. Khajavi Rad A., Mohebbati R., Hosseinian S. Drug-induced nephrotoxicity and medicinal plants. Iran J. Kidney Dis. 2017; 11 (3): 169-179. PMID: 28575877
6. Nedashkivskyi S.M., Kuchma A.B., Struk V.F., Bohomol A.H. Acute renal failure in severe poisonings with methadone. Meditsina Neotlozhnykh Sostoyanii. 2015; 1: 106-110. [In Ukr.]
7. Eizadi-Mood N., Naeini S.A., Hedaiaty M., Sabzghabaee A.M., Moudi M. Prevalence of pulmonary edema among the deceased cases with acute Methadone poisoning: a report from Iran. J. Res. Pharm. Pract. 2016; 5 (4): 290–293. DOI: 10.4103/2279-042X.192454. PMID: 27843967
8. Smirnov A.V., Dobronravov V.A., Rumyantsev A.Sh., Shilov E.M., Vatazin A.V., Kagonov I.G., Kucher A.G., Esayan A.M. Acute kidney injury: basic principles of the diagnosis, prevention and treatment (2015). National guidelines. Part I. Pochki. 2016; 2 (16): 63-84. [In Russ.]
9. Smirnov A.V., Dobronravov V.A., Rumyantsev A.Sh., Shilov E.M., Vatazin A.V., Kagonov I.G., Kucher A.G., Esayan A.M. Acute kidney injury: basic principles of the diagnosis, prevention and treatment (2015). National guidelines. Part II. Pochki. 2016; 3 (17): 39-52. DOI: 10.22141/23071257.3.17.2016.76539. [In Russ.]
10. Mikhalchuk M.A., Shilov V.V., Kalmanson M.L., Velikova V.D. Syndrome of positional compression. Etiology, pathogenesis, diagnostics, clinical presentation, treatment. Sankt Peterburg: izd-vo Politekhnicheskogo Universiteta; 2009: 16-41, 59-65. ISBN 978-5-7422-2129-6. [In Russ.]
11. Ievleva V.I., Bugakov I.E. Crush-syndrome. Meditsina Neotlozhnykh Sostoyanii. 2010; 6: 101-102. [In Russ.]
12. Zhou Y., Hui X., Li N., Zhuang W., Liu G., Wu T., Wei M., Wu X. Saponins from Chinese Buckeye Seed reduce cerebral edema: metaanalysis of randomized controlled trials. Planta Med. 2005; 71 (11): 993-998. DOI: 10.1055/s-2005-871299. PMID: 16320198
13. Nikonov V.V., Savitskaya I.B., Pavlenko A.Yu. Aspects of treatment of cerebral edema with the drug L-Lysine escinate. Ukrainsky Neirokhirurgichesky Zhurnal. 2008; 1: 63-70. [In Russ.]
14. Mosteller R.D. Simplified calculation of body-surface area. N. Engl. J. Med. 1987; 317 (17): 1098. DOI: 10.1056/NEJM198710223171717. PMID: 3657876
15. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney International supplements. 2012; 2 (1): 19-22.
16. Tepaev R.F., Lastovka V.A., Pytal A.V., Savluk Yu.V. Metabolic acidosis: diagnostics and treatment. Pediatricheskaya Farmakologiya. 2016; 13 (4): 384–389. DOI: 10.15690/pf.v13i4.1612. [In Russ.]
Review
For citations:
Livanov G.A., Lodyagin A.N., Razina A.А., Glushkov S.I., Ivanova A.A., Volchkova E.V., Batotsyrenov B.V. Favorable Outcome of Severe Acute Methadone Poisoning (Clinical Case). General Reanimatology. 2018;14(5):25-31. https://doi.org/10.15360/1813-9779-2018-5-25-31