| Myocardial ischemia as a result of severe benzodiazepine and opioid withdrawal. | |
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MedLine Citation:
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PMID: 15902797 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CASE REPORT: A 6-month-old female born at 25 weeks gestation with severe opioid and benzodiazepine dependence resulting from multiple operative procedures and chronic ventilatory support was receiving continuous intravenous infusion of fentanyl and midazolam after trials of enteral methadone and diazepam had been unsuccessful due to gastric intolerance. On postoperative day 5 following Nissen fundoplication and gastrostomy tube placement, she acutely developed tachycardia, hypertension, agitation, loose stools, and yawning. Attempts to provide boluses of benzodiazepines and opioids revealed a very sluggish port in her subclavian central venous catheter. Prompt replacement of the catheter occurred without complication. After resuming infusions and providing additional sedatives and opioids, the loose stools, yawning, and agitation resolved. However, the tachycardia persisted. A 12-lead ECG was notable for significant ST depression in anterior leads. Laboratory studies revealed significantly elevated cardiac enzymes. The patient was transfused with packed red blood cells to optimize oxygen-carrying capacity. Echocardiography demonstrated a small region of dyskinetic apical endocardium. Cardiac enzymes normalized within 48 h. The ECG and echocardiographic findings fully resolved after approximately 70 h. DISCUSSION: We believe that the sluggish central venous catheter port limited delivery of the midazolam and fentanyl to our patient. The resultant tachycardia and hypertension limited diastolic filling of the coronary arteries, resulting in myocardial ischemia. As the withdrawal was treated, heart rate and blood pressure returned to baseline, myocardial perfusion normalized, and the ST depression and the cardiac enzyme values normalized. This report underscores the significant morbidity associated with withdrawal syndromes and the need to recognize withdrawal early and to treat it aggressively. |
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Authors:
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Abhik K Biswas; Brian L Feldman; Daniela H Davis; Eric A Zintz |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Clinical toxicology (Philadelphia, Pa.) Volume: 43 ISSN: 1556-3650 ISO Abbreviation: Clin Toxicol (Phila) Publication Date: 2005 |
Date Detail:
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Created Date: 2005-05-20 Completed Date: 2005-06-02 Revised Date: 2013-05-20 |
Medline Journal Info:
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Nlm Unique ID: 101241654 Medline TA: Clin Toxicol (Phila) Country: United States |
Other Details:
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Languages: eng Pagination: 207-9 Citation Subset: AIM; IM |
Affiliation:
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US Navy Pediatric Critical Care Medicine, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA. akbiswas@mar.med.navy.mil |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adjuvants, Anesthesia
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therapeutic use Analgesics, Opioid / adverse effects* Benzodiazepines / adverse effects* Diazepam / therapeutic use Electrocardiography Female Fentanyl / adverse effects Humans Infant Infant, Newborn Infant, Premature Methadone / adverse effects Midazolam / therapeutic use Myocardial Ischemia / drug therapy, etiology*, physiopathology Neonatal Abstinence Syndrome* / complications*, physiopathology Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Adjuvants, Anesthesia; 0/Analgesics, Opioid; 12794-10-4/Benzodiazepines; 437-38-7/Fentanyl; 439-14-5/Diazepam; 59467-70-8/Midazolam; 76-99-3/Methadone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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