Multiple organ dysfunction
syndrome (MODS) has rarely been described in patients with heroin intoxication.
Here, we report a rare case of MODS involving six organs, due to heroin
intoxication. The patient was a 32-year-old Chinese man with severe heroin
intoxication complicated by acute pulmonary edema and respiratory
insufficiency, shock, myocardial damage and cardiac insufficiency,
rhabdomyolysis and acute renal insufficiency, acute liver injury and hepatic
insufficiency, toxic leukoencephalopathy, and hypoglycemia. He managed to survive
and was discharged after 10 weeks of intensive care. The possible pathogenesis
and therapeutic measures of MODS induced by heroin intoxication and some
suggestions for preventing and treating severe complications of heroin
intoxication, based on clinical evidence and the pertinent literature, are
discussed in this report.
...Possible causes of MODS in this case include hypoglycemia,
prolonged hypoxia, and ischemia caused by respiratory and circulatory
depression due to heroin intoxication [3,15]. These causes can
lead to organ edema and dysfunction [16] because ischemia and hypoxia can result in
acidosis and increase capillary permeability. In addition, ischemia and hypoxia
directly affect the ATP synthesis of cells, which result in damage to cell
membranes, mitochondria and lysosomes, and eventually lead to cell apoptosis
and necrosis [1,16,17]. Hypoglycemia
decreases anaerobic glycolysis and accelerates the depletion of ATP in hypoxia,
which further increases damage to tissues and organs [1,18].
Ischemia-reperfusion produces a large quantity of oxygen free radicals, which
can also cause damage to tissues and organs [12]. Rhabdomyolysis
can cause the release of cell contents into blood, which further damages
tissues and organs [4]. Cell apoptosis and necrosis, and damage to
tissues and organs eventually lead to MODS. Based on these findings, we thought
that the pathogenesis of MODS induced by heroin intoxication should be the
consequences of the primary toxic role of heroin, hypoglycemia, prolonged
hypoxia, and ischemia-reperfusion injury.
Mortality is higher among patients of heroin
intoxication complicated by MODS, if they do not receive timely and effective
medical care [19]. Therefore,
therapeutic measures should include timely and effectively treating respiratory
and circulatory failure to correct for ischemia and hypoxia, and supporting and
protecting the main organ functions...
Below: CT scan of chest revealed
bilateral fluffy infiltrates and exudation, pulmonary interstitial congestion
and edema, bilateral small pleural effusion (A). CT scan of head revealed
marked low attenuation involving basal ganglia region (B), and cerebral white matter
(C). After treatment, follow up CT scan of chest showed clearing of bilateral
lung field (D). Follow up CT scan of head showed improvement of low attenuation
in basal ganglia region (E), and cerebral white matter (F).
Full article at:
By:
1Intensive Care Unit, Gongli Hospital,
Second Military Medical University, Pudong New Area, Shanghai 200135, P. R.
China
2Department of Neurology, Gongli Hospital,
Second Military Medical University, Pudong New Area, Shanghai 200135, P. R.
China
Address correspondence to: Dr. Longxuan Li, Department of Neurology,
Gongli Hospital, Second Military Medical University, 219 Miaopu Rd, Pudong New
Area, Shanghai 200135, P. R. China. Tel: +86 21 5885 8730; Fax: +86 21 5885
8640; E-mail: moc.oohay@6002eelnauxgnoL
More at: https://twitter.com/hiv_insight
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