INTRAVENOUS ADMINISTRATION OF CRUSHED METHADONE AND LUNG DISEASE

Ovisnost o drogama je čimbenik rizika za nastanak brojnih akutnih i kroničnih komplikacija pluća koje se mogu razviti zbog lošeg općeg zdravlja ovisnika, ali i zbog izravnog djelovanja heroina na depresiju disanja. U ovom prikazu slučaja radi se o 40-godišnjem bolesniku koji je zaprimljen na Objedinjeni hitni prijam KB Sveti Duh zbog povišene temperature praćene zimicom, otežanim disanjem i bolovima u lijevoj strani prsišta. Obradom je utvrđena višestruka plućna patologija kao posljedica intravenske primjene drobljenog metadona, a koja je uključivala submasivnu plućnu emboliju, obostranu upalu pluća, poremećaj plućnog intersticija, multiple infarkte pluća te lijevostrani pleuralni izljev. Nakon početne obrade bolesnik je premješten u Jedinicu intenzivnog liječenja gdje je provedeno liječenje nefrakcioniranim heparinom, intravenskim antibioticima, antifungicima, vitaminom B12 te ostalom simptomatskom terapijom. Nakon provedenog liječenja u bolesnika je došlo do poboljšanja laboratorijskih i radioloških nalaza te subjektivnog stanja. Zbog nespecifi čne simptomatologije, te odsustva karakterističnih kliničkih znakova uz često višestruku plućnu patologiju u bolesnika koji uzimaju drogu postavljanje dijagnoze ponekad je izuzetno teško. Iz tog razloga, u svih ovisnika o drogama važan je visok stupanj sumnje uz organizirani dijagnostičko terapijski pristup kako bi se na vrijeme započelo liječenje potencijalno smrtonosnih plućnih komplikacija.A 40-year-old patient with fever, chills and pain in the left side of the chest presented to the Emergency Room (ER), Sveti Duh University Hospital. He had been on dual antibiotic therapy for the last 12 days. He was an otherwise treated opiate addict, now on methadone therapy. History data and physical examination were without particular features, vital indicators were normal, and soon after antipyretic and analgesic therapy the patient reported improvement and suggested discharge from ER. However, upon arrival of the fi ndings, in particular radiological heart and lung examination, additional diagnostic workup was performed. Radiograph of the heart and lungs revealed diffusely decreased ventilation of pulmonary parenchyma bilaterally (reticular nodose interstitium), pronounced vasculature, and intense shadow along the lateral thoracic wall to the right in the basal parts of the upper lobe. Also, due to the radiological fi ndings described, the subsequently mentioned dyspnea and acknowledgment of intravenous administration of crushed methadone and high d-dimer values, multi-slice computed tomography pulmonary angiography was performed, which indicated embolus in the left main branch of the pulmonary artery and in the lobar branch to the lower lobe, right along with peripheral multiple lung infarctions. At the end of ER treatment, it was concluded that the patient had submassive pulmonary embolism, bilateral pneumonia, changes in pulmonary interstitium, and multiple pulmonary infarctions. As a result, the patient was hospitalized in the Intensive Care Unit, treated with unfractionated heparin, intravenous antibiotics, antifungals, vitamin B12 and other symptomatic therapy. After treatment, laboratory and radiological fi ndings and the subjective condition of the patient improved, and he was discharged for home treatment with continued anticoagulation therapy