naloxone and Proteinuria

An Asian multiparous woman weighing 47 kg, who suffered from a rare myopathy, congenital fibre type disproportion, was given morphine 10 mg intramuscularly for labour analgesia. After delivery, she had diastolic hypertension and proteinuria and was prescribed magnesium sulphate. Some hours later she became unresponsive with little respiratory effort. Blood gas analysis revealed a respiratory acidosis. Naloxone administration reversed the symptoms. Further doses were required as the respiratory depression recurred. Opioid-related narcosis is the most likely diagnosis in this case. Other possible differential diagnoses were magnesium overdose or a post-ictal state. The presence of a myopathy could render this patient susceptible to the respiratory effects of opioids. Other explanations for an exaggerated and delayed response to opioids include co-administration of other respiratory depressant drugs such as magnesium sulphate, co-morbidity such as renal impairment and genetic variability in the metabolism of morphine. Robust guidelines and highlighting patients with risk factors are required to prevent this complication from recurring.

Topics: Acidosis, Respiratory; Adult; Analgesia, Obstetrical; Analgesics, Opioid; Anticonvulsants; Blood Gas Analysis; Diagnosis, Differential; Female; Humans; Hypertension; Magnesium Sulfate; Morphine; Myopathies, Structural, Congenital; Naloxone; Narcotic Antagonists; Pre-Eclampsia; Pregnancy; Proteinuria; Risk Factors; Stupor

The relationship between urinary excretion of sex-dependent low molecular weight proteins (LMWP) in male rats and narcotic dependence is described in this study. Rats were intermittently infused with narcotics at one hour intervals through an implanted intravenous cannula. Development of physical dependence on morphine, pethidine, and pentazocine was detected by withdrawal signs including body weight loss and abnormal behaviors after naloxone challenge. In these animals, a significant decrease in urinary LMWP excretion was found following the second day of each drug treatment without significant changes in albumin excretion, and this decrease was observed continuously throughout the experiment. The markedly decreased level of LMWP recovered to the control level within 7 d after withdrawal of the drugs. These results suggest that the decrease in urinary excretion of sex-dependent LMWP in male rats is a phenomenon closely related to narcotic dependence.

Topics: Animals; Female; Humans; Male; Meperidine; Molecular Weight; Morphine; Naloxone; Opioid-Related Disorders; Pentazocine; Proteinuria; Rats; Rats, Inbred Strains; Sex Factors; Substance Withdrawal Syndrome; Time Factors

Attempts have been made to examine the relationship between urinary excretion of sex-dependent low molecular weight proteins found only in male rats (LMWP) and morphine physical dependence. Chronic administration of morphine produced a dose-related decrease in urinary LMWP excretion, which was correlated to the intensity of withdrawal signs including body weight loss and abnormal behaviors recognized after naloxone challenge. Furthermore, a statistically high correlation was obtained between the decrease in urinary LMWP excretion and the loss of body weight precipitated by naloxone challenge. LMWP was identified immunologically in the livers, kidneys, and sera using an antibody against purified LMWP. The serum level of LMWP was increased rapidly following bilateral nephrectomy. After chronic treatment with morphine, the LMWP content in the livers, kidneys, and sera were decreased. These findings indicate that the decrease in urinary LMWP excretion induced by chronic administration of morphine can be a useful parameter to assess the development of physical dependence on narcotics on the peripheral level without requiring drug withdrawal and naloxone challenge. This decrease in urinary LMWP may be caused by the inhibition of LMWP synthesis in the liver.

Topics: Animals; Female; Humans; Kidney; Liver; Male; Molecular Weight; Morphine Dependence; Naloxone; Proteins; Proteinuria; Rats; Rats, Inbred Strains; Sex Factors