heroin and Hepatic-Encephalopathy

Detecting undisclosed methamphetamine and heroin abuse is a challenge for life underwriters and medical directors. A common clinical assumption is that if substance abusers experience liver damage, it will be indicated by elevated serum transaminases. The following case suggests that assumption may not be true for heavy substance abusers who consume no or minimal alcohol. This report describes a 44-year-old male with long-term use of inhaled combined methamphetamine and heroin ("speedballs") and minimal alcohol use, whose transaminases remained normal while episodes of acute liver failure and transient hepatic encephalopathy from hyperammonemia were observed. In this case, a fatal motor vehicle accident occurred following the sudden onset of hepatic encephalopathy hours after consuming a "speedball." Normal transaminases may not be proof of a normal healthy liver among methamphetamine and heroin abusers.

Topics: Adult; Hepatic Encephalopathy; Heroin; Heroin Dependence; Humans; Male; Methamphetamine

Topics: Acute Kidney Injury; Administration, Oral; Adolescent; Alkaline Phosphatase; Amenorrhea; Amphetamine; Barbiturates; Cannabis; Child; Cocaine; Eosinophilia; False Positive Reactions; Female; Hepatic Encephalopathy; Hepatitis B; Heroin; Humans; Injections, Intravenous; Injections, Subcutaneous; Juvenile Delinquency; Lysergic Acid Diethylamide; Peptic Ulcer; Pneumonia; Pseudotumor Cerebri; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adolescent; Biliary Tract Diseases; Brain Diseases; Chemical and Drug Induced Liver Injury; Child; Chronic Disease; Electroencephalography; Exchange Transfusion, Whole Blood; Female; Hepatic Encephalopathy; Hepatitis; Heroin; Humans; Male; Methods; Neurologic Manifestations; Plasma Substitutes; Plasmapheresis