Addiction & Health

Addiction & Health

Acute Respiratory Distress Syndrome in a 28-Year-Old Male Subsequent to Inappropriate Naloxone Administration

Document Type : Case Report(s)

Authors
Foroozan Faress 1
Zeynab Nasri Nasrabadi 2
Motahareh Aghajani Delavar 2
Kurosh Jodaki 3
Sayed Mahdi Marashi 1
1 Department of Forensic Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 Department of pediatrics, School of Medicine, Iran University of Medical Sciences, Aliasghar Children Hospital, Tehran, Iran
3 School of Nursing and Midwifery, Shohadaye Haft-e Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
10.34172/ahj.1629
Abstract
Tramadol, a centrally-acting analgesic, is widely used for the management of moderate to severe pain. It is preferred in clinical settings due to its superior effectiveness and safety profile compared to other opioids. However, recent research has indicated a potential risk of tramadol-induced seizures, especially when consumed in high dosages or in combination with other substances. We present a case of a 28-year-old male who was brought to the Emergency Department approximately 30 minutes after administering 0.4 mg of naloxone intravenously by Emergency Medical Services (EMS) personnel. The administration was necessitated by a decline in the patient’s level of consciousness, the onset of lip cyanosis, and suspected tramadol poisoning. The patient was intubated on-site before being transported to the Emergency Department. Upon arrival, despite receiving 40% FiO2, his O2 saturation was at 88%. Bibasilar crackles were detected during chest auscultation. A CT scan of his chest revealed the presence of bilateral alveolar infiltrates, primarily in the lower lobes. As a result, the patient was diagnosed with acute respiratory distress syndrome and was transferred to the intensive care unit for further care.

Highlights

Sayed Mahdi Marashi(Google Scholar)(Pubmed)

Keywords
Tramadol
Poisoning
Naloxone
Respiratory insufficiency
  1. Gioia S, Lancia M, Bacci M, Suadoni F. Two fatal intoxications due to tramadol alone: autopsy case reports and review of the literature. Am J Forensic Med Pathol 2017;38(4):345-8. doi:10.1097/paf.0000000000000338
  2. Nakhaee S, Hoyte C, Dart RC, Askari M, Lamarine RJ, Mehrpour O. A review on tramadol toxicity: mechanism of action, clinical presentation, and treatment. Forensic Toxicol 2021;39(2):293- 310. doi:10.1007/s11419-020-00569-0
  3. Wang SQ, Li CS, Song YG. Multiply organ dysfunction syndrome due to tramadol intoxication alone. Am J Emerg Med 2009;27(7):903.e5-7. doi:10.1016/j.ajem.2008.11.013
  4. Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome. Lancet 2021;398(10300):622-37. doi:10.1016/ s0140-6736(21)00439-6
  5. Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, et al. Acute respiratory distress syndrome. Nat Rev Dis Primers 2019;5(1):18. doi:10.1038/s41572-019-0069-0
  6. Hoffman RS, Howland MA, Levin NA, Nelson LS, Goldfrank LR. Goldfrank’s Toxicologic Emergencies. 10th ed. New York: McGraw Hill; 2014.
  7. Dahan A, van der Schrier R, Smith T, Aarts L, van Velzen M, Niesters M. Averting opioid-induced respiratory depression without affecting analgesia. Anesthesiology 2018;128(5):1027- 37. doi:10.1097/aln.0000000000002184
  8. Al-Azzawi M, Alshami A, Douedi S, Al-Taei M, Alsaoudi G, Costanzo E. Naloxone-induced acute pulmonary edema is dose-dependent: a case series. Am J Case Rep 2021;22: e929412. doi:10.12659/ajcr.929412
  9. Lemyze M, Mallat J. Understanding negative pressure pulmonary edema. Intensive Care Med 2014;40(8):1140-3. doi:10.1007/s00134-014-3307-7
  10. Magazine R, Rao S, Chogtu B. Prescribing patterns of drugs in acute respiratory distress syndrome (ARDS): an observational study. J Clin Diagn Res 2015;9(2): FC01-4. doi:10.7860/ jcdr/2015/10411.5519
Addiction & Health
Volume 18
Pages 1-3