heroin and Hypoglycemia

Topics: 17-Hydroxycorticosteroids; Adult; Clinical Trials as Topic; Corticotropin-Releasing Hormone; Feedback; Glucocorticoids; Heroin; Humans; Hypoglycemia; Hypothalamo-Hypophyseal System; Insulin; Male; Methadone; Metyrapone; Middle Aged; Periodicity; Pituitary-Adrenal System; Stress, Physiological; Substance-Related Disorders

The survival to discharge rate after unwitnessed, non-cardiac out-of-hospital cardiac arrest (OHCA) is dismal. We report the successful use of therapeutic hypothermia in a 26-year old woman with OHCA due to intentional poisoning with heroin, amphetamine and insulin.The cardiac arrest was not witnessed, no bystander CPR was initiated, the time interval from the call to ambulance arrival was 9 minutes and the initial cardiac rhythm was asystole. Eight minutes of advanced cardiac life support resulted in ROSC.Upon hospital admission, the patient's pupils were dilated. Her arterial lactate was 17 mmol/l, base excess -20, pH 6.9 and serum glucose 0.2 mmol/l. During the first 24 hours in the ICU, the patient developed maximally dilated pupils not reacting to light and became increasingly haemodynamically unstable, requiring both inotropic support and massive fluid resuscitation. After 1 week in the ICU, however, she made an uneventful recovery with a Cerebral Performance Category of 1 at hospital discharge and at a follow up examination at 6 months.. According to most prognostic factors, the patient had a statistical chance for survival of less than 1%, not taking into account her severe state of hypoglyaemia. We suggest that this case exemplifies the need for more studies on the use of TH in non-coronary causes of OHCA.

Topics: Adult; Amphetamine; Brain Injuries; Female; Heart Arrest; Heroin; Humans; Hypoglycemia; Hypothermia, Induced; Insulin; Prognosis

The survival of heroin overdose patients resuscitated from cardiac arrest is reported to be poor. The aim of our study was to investigate the outcome and characteristics of survivors after cardiac arrest caused by heroin overdose.. This was a retrospective study in a medium-sized city (population, 560,000). Between 1 January 1997 and 31 December 2000, there were 94 combined cardiac arrests caused by acute drug poisonings. The main outcome measure was survival to discharge.. Cardiopulmonary resuscitation was attempted in 19 heroin overdose patients (group A) and in 53 patients with cardiac arrest caused by other poisonings (group B). Three (16%) vs. six (11%) patients were discharged alive (group A vs. B, respectively). The survivors in group A had an Emergency Medical Service (EMS)-witnessed cardiac arrest or the Emergency Dispatching Centre was called before the arrest occurred. There was no statistically significant difference between the two groups in terms of survival. Survivors in both groups suffered from acute renal failure (two), hypoglycaemia (four) and hypothermia (three).. Survival after cardiac arrest caused by heroin overdose is possible if the arrest is EMS witnessed or the Emergency Dispatching Centre is called before the cardiac arrest occurs. In comparison with cardiac arrests caused by other poisonings, there was no difference in survival. The incidence and mechanism of hypoglycaemia should be examined in further studies.

Topics: Adult; Cardiac Output; Cardiopulmonary Resuscitation; Drug Overdose; Emergency Medical Services; Epinephrine; Female; Finland; Heart Arrest; Heroin; Heroin Dependence; Humans; Hypoglycemia; Male; Middle Aged; Narcotics; Rhabdomyolysis; Survival; Vasoconstrictor Agents

Topics: Adult; Blood Glucose; Fatty Acids, Nonesterified; Glucose Tolerance Test; Growth Hormone; Heroin; Humans; Hydrocortisone; Hypoglycemia; Hypothalamo-Hypophyseal System; Insulin; Luteinizing Hormone; Male; Methadone; Substance-Related Disorders; Thyroxine; Triiodothyronine