Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

Abstract

Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

Managing Subarachnoid Hemorrhage Precipitated by Anesthesia-assisted Rapid Opioid Detoxification: A Case Report

“… 3 These surges produce electrolyte derangements and respiratory alkalosis, which have been linked to episodes of cardiac arrest and seizure in previous opioid withdrawal cases. 4 , 5 Outside of opioid withdrawal, massive catecholamine surges have been documented as possible precipitants of subarachnoid hemorrhage. 6 Historically, treatment regimens focused on treating the acute sympathetic overdrive with alpha-2 agonists and benzodiazepines and weaning patients with long-acting opioid agonists such as methadone and buprenorphine.…”

“…Reported complications from the procedure include the following: those due to opioid withdrawal symptoms, such as vomiting, diarrhea, hypovolemia and electrolyte abnormalities; those related to adverse effects of the resultant catecholamine surge; and complications arising from general anesthesia. 4,5 Documented adverse outcomes of AAROD include severe psychiatric disturbances, aspiration, cardiac dysthymias, cardiac arrest, respiratory arrest and death. [10][11][12] In our literature review, we did not find any previously documented cases of subarachnoid hemorrhage following AAROD.…”

Opioid substitution therapy or hidden opioids are a minefield for nalmefene: an atypical case series of 11 patients in Lorraine

“…No published case series referred neither to an analgesic opioid drug nor to an antidiarrheal opioid analog. On the other hand, cases of OWS were already reported with the association between OST and naltrexone, another opioid antagonist used in alcohol dependence despite a clear mention in SPC . Prescribers should be aware of these interactions, as the alcoholic comorbidity is common in patients under OST .…”