Pulmonary edema in acute heroin poisoning

Silber, Robert; Clerkin, Eugene P.

doi:10.1016/0002-9343(59)90075-0

Cited by 44 publications

(3 citation statements)

References 10 publications

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“…Lung weights in such cases often exceed 500 g each, and may on occasion exceed 1000 g each (126). The observation of such marked pulmonary edema from opioid overdose was first reported by William Osler in 1880 (127), and since then, it has been widely reported in the literature (125,(128)(129)(130)(131)(132). Although the phenomenon of pulmonary edema in these cases is well-described, it is poorly understood.…”

Section: Invited Reviewmentioning

confidence: 99%

Opioid Toxicity

Dolinak

2017

Academic Forensic Pathology

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In recent years, there has been a substantial increase in opioid use and abuse, and in opioid-related fatal overdoses. The increase in opioid use has resulted at least in part from individuals transitioning from prescribed opioids to heroin and fentanyl, which can cause significant respiratory depression that can progress to apnea and death. Heroin and fentanyl may be used individually, together, or in combination with other substances such as ethanol, benzodiazepines, or other drugs that can have additional deleterious effects on respiration. Suspicion that a death is drug-related begins with the decedent's medical and social history, and scene investigation, where drugs and drug paraphernalia may be encountered, and examination of the decedent, which may reveal needle punctures and needle track marks. At autopsy, the most significant internal finding that is reflective of opioid toxicity is pulmonary edema and congestion, and frothy watery fluid is often present in the airways. Various medical ailments such as heart and lung disease and obesity may limit an individual's physiologic reserve, rendering them more susceptible to the toxic effects of opioids and other drugs. Although many opioids will be detected on routine toxicology testing, more specialized testing may be warranted for opioid analogs, or other uncommon, synthetic, or semisynthetic drugs.

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Section: Invited Reviewmentioning

confidence: 99%

Opioid Toxicity

Dolinak

2017

Academic Forensic Pathology

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“…The respiratory depression is maximal within 7 minutes after intravenous administration of morphine but may not occur until 30 minutes after an intramuscular injection or 90 minutes after subcutaneous injection 9 . Heroin-related pulmonary oedema is a rare complication of heroin use if one considers the fact that most users inject 3± 4 times each day 16,17 . It was reported in association with morphine by Osler as early as 1880 which was 18 years before heroin was ® rst manufactured 18 .…”

Section: Respiratory Systemmentioning

confidence: 99%

Clinical features of drug use and drug use related HIV

Brettle¹

1996

Int J STD AIDS

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A variety of important medical problems, both non-infective and infective in nature, are associated with drug use. A number of micro-organisms are associated with the non-sterile nature of injection drug use (IDU) whilst a number of blood borne viruses, including retroviruses such as HIV, are easily transmitted to individuals involved in the sharing of injection equipment. Practitioners require knowledge of infection and non-infection related medical conditions associated with IDU since they may mimic each other.

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“…Pulmonary edema is the most common complication of heroin overdose. 15,18,45,47,72,76 The mortality rate associated with heroininduced pulmonary edema has been as high as 18.3 percent, but this occurred before the widespread use of positive-end expired pressure (PEEP) therapy with mechanical ventilation. 15 The pulmonary edema usually appears within several hours but is occasionally delayed.…”

Section: Pulmonary Edemamentioning

confidence: 99%

Effects of Heroin, Morphine, Methadone, and Propoxyphene on the Lung

Brashear¹

1980

Semin Respir Crit Care Med

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Pulmonary edema in acute heroin poisoning

Cited by 44 publications

References 10 publications

Opioid Toxicity

Opioid Toxicity

Clinical features of drug use and drug use related HIV

Effects of Heroin, Morphine, Methadone, and Propoxyphene on the Lung

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