heroin and Alcoholic-Intoxication

During acute intoxications rhabdomyolysis appear with a great clinical polymorphism. The muscular involvement is not always evident because of its shortness and latence. Practically the problem is one of localised muscle damage, hyperkaliema or acute renal insufficiency. The serum isoenzymes of CPK levels, the presence of myoglobinuria are necessary for the diagnosis. The most serious rhabdomyolysis depend on the added injury of respiratory muscles and myocardium. Many toxic substances can involve rhabdomyolysis but the most frequent ones are sedatives, carbonic oxyde, ethanol. Only the complications are treated.

Topics: Alcoholic Intoxication; Anesthesia, General; Animals; Carbon Monoxide Poisoning; Foodborne Diseases; Glycyrrhiza; Heroin; Humans; Hypnotics and Sedatives; Muscles; Myoglobinuria; Plants, Medicinal; Poisoning; Quail; Succinylcholine

Topics: 1-Propanol; Alcoholic Intoxication; Amphetamine; Carbon Monoxide Poisoning; Chloral Hydrate; Chlordiazepoxide; Dextropropoxyphene; Diazepam; Ethchlorvynol; Glutethimide; Heroin; Humans; Meprobamate; Methadone; Methanol; Morphine; Orphenadrine; Paraldehyde; Pentazocine; Phenothiazines; Phenytoin; Poisoning; Quinine; Salicylates; Toxicology; Tranquilizing Agents

Abnormal restricted diffusion on magnetic resonance imaging is often associated with ischemic stroke or anoxic injury, but other conditions can present similarly. We present six cases of an unusual but consistent pattern of restricted diffusion in bilateral hippocampi and cerebellar cortices. This pattern of injury is distinct from typical imaging findings in ischemic, anoxic, or toxic injury, suggesting it may represent an under-recognized clinicoradiographic syndrome. Despite initial presentation with stupor or coma in the context of obstructive hydrocephalus, patients may have acceptable outcomes if offered early intervention.. We identified an ad hoc series of patients at our two institutions between years 2014 and 2017 who presented to the neurocritical care unit with severe, otherwise unexplained cerebellar edema and retrospectively identified several commonalities in history, presentation, and imaging.. Between two institutions, we identified six patients-ages 33-59 years, four male-with similar presentations of decreased level of consciousness in the context of intoxicant exposure, with acute cytotoxic edema of the cerebellar cortex, hippocampi, and aspects of the basal nuclei. All patients presented with severe cerebellar edema which led to obstructive hydrocephalus requiring aggressive medical and/or surgical management. The five patients who survived to discharge demonstrated variable degrees of physical and memory impairment on discharge and at follow-up.. We present findings of a potentially novel syndrome involving a distinct pattern of cerebellar and hippocampal restricted diffusion, with imaging and clinical characteristics distinct from ischemic stroke, hypoxic injury, and known toxidromes and leukoencephalopathies. Given the potential for favorable outcome despite early obstructive hydrocephalus, early identification and treatment of this syndrome are critical.

Topics: Adult; Alcoholic Intoxication; Amphetamines; Basal Ganglia; Benzodiazepines; Brain Edema; Central Nervous System Stimulants; Cerebellar Cortex; Cerebellum; Cocaine; Coma; Female; Heroin; Hippocampus; Humans; Hydrocephalus; Hydromorphone; Magnetic Resonance Imaging; Male; Middle Aged; Opiate Alkaloids; Pain, Postoperative; Stupor; Substance-Related Disorders; Syndrome

To provide references for forensic expertise by investigating the kinds of toxicant, routes of exposure and manners of poisoning deaths, etc.. Six hundred and seven autopsy cases of poisoning deaths from 1957 to 2008 in Department of Forensic Medicine, Tongji Medical College (Tongji Forensic Science Identification Center of Hubei), were comparatively reviewed.. In 218 cases from 1999 to 2008, more than 50% of decedents were male in the ages of 30-49. The toxicants are usually taken orally and the most common manner of death was accidental. The common substances involved in poisoning death were rodenticide, poisoning gas and insecticide. Compared to the data of 1983-1998 and 1957-1982, the common toxic agents had changed significantly. The number of cases involving insecticide and cyanide poisoning decreased in recent years, and the number of cases of rodenticide, poisoning gas, alcohols poisoning displayed an increase tendency, especially for drugs abuse.. Poisoning deaths of pesticides remain a major public health problem for a long time and the awareness of prevention need to be raised, especially for the prevention of deaths from multiple poisons.

Topics: Accidents; Adolescent; Adult; Age Distribution; Aged; Alcoholic Intoxication; Anesthetics; Autopsy; Carbon Monoxide Poisoning; Cause of Death; Child; Child, Preschool; China; Female; Forensic Medicine; Heroin; Humans; Hypnotics and Sedatives; Infant; Male; Middle Aged; Pesticides; Poisoning; Retrospective Studies; Rodenticides; Sex Distribution; Suicide; Young Adult

We argue for a translational approach to addiction science, using an important current research question as a case study.. What is the evidence in support of the hypothesis that alcohol increases the risk of a heroin/opiate overdose through a pharmacological interaction?. The positive epidemiological evidence shows that opiate overdose deaths rarely involve a single drug; that alcohol is the most common other drug involved; that there is a negative association between alcohol and morphine concentration at post mortem; and that post-mortem levels of morphine are often below the levels expected of highly tolerant individuals. The evidence is consistent with the hypothesis that heroin users who drink may require less heroin to overdose than those who do not drink (all other factors being equal) because of a pharmacological interaction. However, the evidence is consistent with, and does not rule out, other causal (and non-causal) pathways. Alcohol could be associated negatively with tolerance, or confounded by other factors. Experimental evidence is required which is unlikely to be obtained through further epidemiological study or through randomized clinical trials.. We believe that animal models could provide the key evidence to test the hypothesis for a 'pharmacodynamic' or 'pharmacokinetic' interaction, which could be corroborated in clinical challenge studies and epidemiological studies. Such a translational approach demands greater collaboration between addiction scientists from basic to applied science and from neuroscience to social science, and would be able to address other key research questions and hypotheses in addiction.

Topics: Alcoholic Intoxication; Analgesics, Opioid; Animals; Behavior, Addictive; Drug Overdose; Evidence-Based Medicine; Heroin; Humans; Risk Factors

We describe the first case of paroxysmal nonkinesogenic dyskinesia secondary to pallidal ischaemia, which is uniquely and specifically triggered by alcohol.

Topics: Adult; Alcohol-Induced Disorders, Nervous System; Alcoholic Intoxication; Alcoholism; Basal Ganglia Diseases; Chorea; Drug Overdose; Dyskinesia, Drug-Induced; Globus Pallidus; Heroin; Humans; Hypoxia-Ischemia, Brain; Illicit Drugs; Magnetic Resonance Imaging; Male; Neurologic Examination; Risk Factors; Substance-Related Disorders

Clinical judgement of intoxicated patients is difficult. In the emergency department of the inner city of Oslo this is done every day.. During a one-year period from 1998-99, a group of 429 first-time admitted intoxicated patients were included in a study. The patients and the method of observation are described.. 75% of the patients were men; 45% reported to have consumed alcohol only, while 10% had taken a heroin overdose. The rest had used various combinations of legal and illegal drugs. Female patients were younger than male patients (29 versus 36 years, p < 0.00), and patients intoxicated only on alcohol were on the average older than patients who had taken drugs (38 versus 31 years, p < 0.00). 57 patients were hospitalized, seven of them had serious intracerebral conditions.. Our study indicates that systematic observation over some hours, repeated clinical examinations, and the systematic use of a modified Glasgow Coma Scale makes it possible to sort out the seriously ill from "only" intoxicated patients.

Topics: Adult; Alcoholic Intoxication; Critical Illness; Diagnosis, Differential; Drug Overdose; Emergency Service, Hospital; Female; Glasgow Coma Scale; Heroin; Heroin Dependence; Humans; Male; Monitoring, Physiologic; Norway; Poisoning; Substance-Related Disorders; Wounds and Injuries

Death due to heroin overdose and/or rapid injection of heroin is a frequent occurrence among opioid addicts. We present an unusual case of heroin fatality due to the injection of the drug in the penis. Blood, urine, bile, and vitreous humor concentrations of morphine were 0.68, 0.49, 0.32 and 0.062 microg/ml, respectively. Ethanol was detected at concentrations of 104, 124, 106, and 94 mg/dl in the blood, urine, bile, and vitreous humor, respectively. The cause of death was determined to be due to heroin and ethanol intoxication.

Topics: Alcoholic Intoxication; Cause of Death; Drug Overdose; Fatal Outcome; Forensic Medicine; Heroin; Humans; Injections; Male; Middle Aged; Morphine; Narcotics; Penis; Tissue Distribution

The purpose of this study was to evaluate the role of ethanol in deaths due to heroin intoxication. Over a 12 month period, all cases investigated by the Office of the Chief Medical Examiner, State of Maryland where a blood screen by Roche Abuscreen radioimmunoassay (RIA) was positive at a cutoff of 100 ng/mL were included in the study. Free morphine was quantitated using the Coat-A-Count RIA and ethanol was quantitated by head space gas chromatography. All presumptive morphine positive cases were confirmed by gas chromatography/mass spectrometry. Seventy of the 119 cases where death was attributed to narcotic or alcohol and narcotic intoxication had blood ethanol concentrations (BAC) greater than or equal to 0.02 g/dL; 48 had BAC > or = 0.10 g/dL. Only 3 of 45 cases where morphine was identified but was unrelated to death had BAC > or = 0.02 g/dL. At all ranges of free morphine concentrations, there was a greater percentage of narcotic deaths when ethanol was present. From the data, we conclude that 1) the use of even small amounts of ethanol with heroin is clearly a risk factor in deaths due to heroin, 2) there are some heroin deaths where no free morphine is identified in the blood. In these deaths, ethanol is unlikely to be present, 3) at blood ethanol concentrations between 0.20 and 0.29 g/dL, the morphine concentrations in heroin deaths increased significantly, 4) at blood ethanol concentrations greater than 0.30 g/dL, morphine became less of a factor than the ethanol in causing death.

Topics: Alcoholic Intoxication; Cause of Death; Chromatography, Gas; Drug Overdose; Ethanol; Heroin; Humans; Morphine; Radioimmunoassay; Risk Factors; Substance-Related Disorders

Deaths associated with injected street preparations of heroin increased substantially in the District of Columbia between April 1979 and December 1982. The 1981 population-based mortality rate (17.4 per 100,000) is possibly the highest ever reported. A case-control study based on toxicologic analyses of postmortem blood samples indicates that concentrations of both heroin and ethanol are substantial risk factors for heroin-related deaths. Analyses of the composition of street-level preparations of heroin and quarterly mortality indicate that the quantity of heroin in packages sold on the street, the price of heroin in these packages, and the quinine weight per package each predict deaths equally as well. An increase in the causal use of heroin in combination with ethanol and quinine is the probable cause of this epidemic.

Topics: Adolescent; Adult; Alcoholic Intoxication; Costs and Cost Analysis; District of Columbia; Drug Contamination; Ethanol; Female; Heroin; Humans; Illicit Drugs; Male; Morphine; Pharmaceutical Preparations; Quinine; Risk; Substance-Related Disorders

Topics: Adult; Alcoholic Intoxication; Anuria; Arm; Heroin; Humans; Male; Oliguria; Paralysis; Substance-Related Disorders

On-site investigations involving interviews with spouses, friends, coworkers, supervisors, and commanders were conducted following 37 deaths or near-deaths by drug overdose among U.S. soldiers stationed in Europe. Subjects were all active-duty soldiers put on the seriously ill list at any Army hospital with an initial diagnosis which included suspected drug overdose. Victims were typically single Black males, less than 22, high school graduates in excellent health. They had been in Germany 7-24 months, liked their jobs, and were judged better than average workers by both peers and supervisors. Fifty percent played on a unit sports team, 6 of 10 had German girlfriends, and one-third had prior disciplinary problems. Although nearly half had been previously identified as having a drug or alcohol problem, only two or three could be called addicts in even the broadest sense. Six cases were suicide gestures, and only these six cases did not involve heroin and/or alcohol. The modal case followed a party, with substantial drinking. In only 25% of the cases did the victim collapse upon injection. More often he went to bed, vomited during the night, and choked on or inhaled vomitus. The data suggest reexamination of two common myths: that heroin users comprise a very unique, albeit undesirable, sample of the general population; and that "overdose" deaths are the result of ignorance, incompetence, or indifference.

Topics: Adult; Age Factors; Alcoholic Intoxication; Black or African American; Black People; Europe; Heroin; Heroin Dependence; Humans; Male; Marriage; Military Personnel; Substance-Related Disorders; Suicide

Behavioral and familial correlates of predominantly White, suburban heroin abusers were investigated to determine whether such abuse was self-contained experimentation or suggestive of generalized personality disorders and impaired family relationships. Twenty of 296 male high school students recruited from 10 middle-class suburban schools had engaged in episodic heroin abuse. Of 29 antisocial behaviors other than heroin abuse assessed, heroin abusers engaged in 16 significantly more frequently. Heroin abusers found their fathers to be significantly less nice, honest, strong, and kind than did nonabusers, according to semantic differential technique. They found themselves to be significantly less strong than did nonabusers, suggesting failure to model themselves after adequately coping fathers. Heroin abusers also found their mothers to be significantly less fair, honest, and valuable than did nonabusers. It was concluded that episodic heroin abuse among suburban adolescents is suggestive both of generalized antisocial behavior and of impaired family relationships.

Topics: Adolescent; Alcoholic Intoxication; Family; Father-Child Relations; Heroin; Humans; Male; Mother-Child Relations; New Jersey; Self Concept; Social Behavior; Substance-Related Disorders; Urban Population

Topics: Acute Kidney Injury; Adolescent; Adult; Alcoholic Intoxication; Arm Injuries; Brachial Plexus; Coma; Hemoglobins; Heroin; Humans; Leg Injuries; Male; Myoglobin; Paralysis; Peripheral Nerve Injuries; Pressure; Secobarbital; Substance-Related Disorders

Topics: Adolescent; Adult; Affective Symptoms; Alcoholic Intoxication; Ambulatory Care; Employment; Evaluation Studies as Topic; Female; Heroin; Hospitalization; Humans; Male; Methadone; Middle Aged; Outpatient Clinics, Hospital; Social Adjustment; Social Behavior Disorders; Socioeconomic Factors; Substance-Related Disorders