heroin and Acidosis

The authors report two cases of heroin induced pulmonary edema. In both cases the severity of respiratory failure, attested by a deep hypoxemia (paO2 28 and 32 mmHg) and a metabolic and respiratory acidosis (pH 7.07 and 7.14) imposed an artificial ventilation with positive end expiratory pressure (PEEP). Hemodynamic study revealed a noncardiogenic edema. In both cases, a cardiac insufficiency was also present : in the first case it's etiology remained unclear, in the second it was a complication of hyperkalemia.

Topics: Acidosis; Adult; Hemodynamics; Heroin; Humans; Male; Positive-Pressure Respiration; Pulmonary Edema; Time Factors

Acute hemodynamic changes during heroin overdose have not been frequently reported. We observed 2 male patients aged 24 and 21 years admitted in coma and shock and presenting severe mixed acidosis, with, respectively, pH 6.80, PaCO2 72 mm Hg, PaO2 70 mm Hg, BE -18 mEq/l, lactic acid 16.5 mmol/l, and pH 6.86, PaCO2 94 mm Hg, PaO2 46 mm Hg, BE -16 mEq/l, lactic acid 5.45 mmol/l. The hemodynamic data of the first patient showed a low output failure state associated with high filling pressures, suggesting biventricular heart failure. In the second case, clinically and radiologically marked pulmonary edema was associated with a hyperdynamic state and moderately elevated pulmonary artery pressure, but normal pulmonary capillary pressure. The possible pathophysiological mechanisms of those different, hemodynamic patterns are discussed.

Topics: Acidosis; Adult; Bicarbonates; Blood Pressure; Heart Rate; Heart Ventricles; Hemodynamics; Heroin; Humans; Intracranial Pressure; Male; Pulmonary Artery; Pulmonary Edema

Topics: Acidosis; Animals; Carbon Radioisotopes; Cattle; Cells, Cultured; Choline; Chromatography, Thin Layer; Dexamethasone; Fetus; Heroin; Lung; Methionine; Phosphatidylcholines; Rabbits; Stimulation, Chemical; Thyroxine; Time Factors; Tritium

Topics: Acidosis; Acidosis, Respiratory; Airway Obstruction; Carbon Dioxide; Heroin; Humans; Hypercapnia; Hypothyroidism; Hypoventilation; Hypoxia; Lung Diseases, Obstructive; Neuromuscular Diseases; Oxygen; Pulmonary Alveoli; Pulmonary Circulation; Pulmonary Edema; Pulmonary Embolism; Respiration; Respiratory Insufficiency; Ventilation-Perfusion Ratio; Work of Breathing

Topics: Acidosis; Acidosis, Respiratory; Adolescent; Adult; Carbon Dioxide; Coma; Female; Heroin; Humans; Hypoventilation; Hypoxia; Lung; Lung Compliance; Male; Pulmonary Alveoli; Pulmonary Circulation; Pulmonary Diffusing Capacity; Pulmonary Edema; Pulmonary Ventilation; Radiography; Respiration; Spirometry; Substance-Related Disorders; Vital Capacity