scholarly journals Microdose induction of buprenorphine-naloxone in a patient using high dose methadone: A case report

2021 ◽  
Vol 11 (6) ◽  
pp. 369-372
Author(s):  
Shannon Menard ◽  
Archana Jhawar
Keyword(s):  
Case Report ◽  
Opioid Dependence ◽  
Psychiatric Service ◽  
Wait Time ◽  
High Dose ◽  
Mu Opioid ◽  
Opioid Receptor Agonist ◽  
Patient Reported ◽  
High Doses ◽  
Time Required

Abstract Background Buprenorphine is a partial mu-opioid receptor agonist approved for the treatment of opioid dependence. The risk of withdrawal symptoms and wait time required to safely initiate buprenorphine provides challenges to both patients and providers. Microdose induction is proposed as a possible solution to ease the transition to buprenorphine; however, little data has been published to date on patients stabilized on methadone doses greater than 100 mg. Case Report A 29-year-old patient stabilized on methadone 105 mg was successfully transitioned to sublingual buprenorphine-naloxone using a 7-day microdose protocol on an inpatient psychiatric service. During the transition, the patient reported only minimal symptoms. Conclusion This report adds to the growing literature supporting the use of a microdose induction to initiate buprenorphine-naloxone. Additionally, this approach may be significant for patients stabilized on high doses of methadone who may not be able to tolerate a traditional buprenorphine induction.

Perioperative dilemma: Challenges of the management of a patient on mega doses of morphine and methadone

2014 ◽  
Vol 10 (1) ◽  
pp. 69 ◽  
Author(s):  
Alan David Kaye, MD, PhD, DABA, DABPM, DABIPP ◽  
Aymen A. Alian, MD ◽  
Nalini Vadivelu, MD ◽  
Keun Sam Chung, MD
Keyword(s):  
Back Pain ◽  
Case Report ◽  
High Dose ◽  
Successful Management ◽  
Present Case Report ◽  
Opioid Induced Hyperalgesia ◽  
History Of ◽  
High Doses

High doses of opioids are often needed in the management of cancer-related pain. A discussion of a patient’s perioperative opioid management and mechanisms contributing to opioid-induced hyperalgesia (OIH) are presented. In the present case report, a patient on high doses of opioids, including morphine and methadone, with severe worsening back pain and a history of increasing opioid requirements for the last 2 months due to metastatic leiomyosarcoma to the femur, spine, and neck is described. Use of high dose opioids is associated with numerous challenges, including tolerance. The successful management of this patient was multimodal and included the use of potent analgesics, N-methyl-D-aspartatereceptor antagonists, and the α-2 agonist clonidine.

scholarly journals A Case Report of Cardiogenic Syncope Due to Loperamide Abuse: Acute Presentation and Novel Use of Buprenorphine

2021 ◽  
Vol 2 (5) ◽  
pp. 214-217
Author(s):  
David Betting ◽  
James Chenoweth ◽  
Angela Jarman
Keyword(s):  
Case Report ◽  
Sodium Bicarbonate ◽  
Alternative Treatment ◽  
Opioid Dependence ◽  
Intestinal Tract ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Acute Presentation ◽  
Cardiogenic Syncope ◽  
High Doses

Introduction: Loperamide is a non-prescription anti-diarrheal agent targeting µ-opioid receptors in the intestinal tract. At high doses it crosses the blood-brain barrier, where µ-opioid agonism can cause euphoric effects. Misuse has been increasing for both the euphoric effects and as an alternative treatment for opioid dependence and withdrawal. Case Report: Here we report the case of a 30-year-old woman presenting with syncope, who was found to have severe myocardial conduction delays in the setting of chronic loperamide abuse. Conclusion: Treatment with sodium bicarbonate and hypertonic sodium resulted in improvement of her conduction abnormalities. Prior to discharge she was initiated on buprenorphine for her opioid use disorder.

scholarly journals Case Report: Enhanced Diazepam Elimination With the Molecular Adsorbents Recirculating System (MARS) in Severe Autointoxication: A Survival Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Anna Dobisova ◽  
Peter Vavrinec ◽  
Diana Vavrincova-Yaghi ◽  
Andrea Gebhardtova ◽  
Robert H. Henning ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Plasma Level ◽  
High Dose ◽  
Mechanically Ventilated ◽  
First Case ◽  
Blood And Urine Samples ◽  
Repeated Doses ◽  
High Doses ◽  
Elimination Clearance

Objective: Due to the extensive use of diazepam worldwide, self-induced intoxication is very common, yet rarely fatal. Nevertheless, the management of intoxication caused by extremely high doses of diazepam is not known, as well as the effectiveness of flumazenil, a specific benzodiazepine (BDZ) antagonist. Here we present the first report on the enhanced elimination (clearance) of diazepam using the Molecular Adsorbents Recirculating System (MARS) following autointoxication with an extremely high dose as part of a suicide attempt.Case: A 44-year-old male patient was admitted to the ICU because of impaired consciousness following the ingestion of 20 g of diazepam. Blood and urine samples revealed high benzodiazepine levels. Repeated doses of flumazenil were without effect on consciousness. Following deterioration of the patient's clinical condition, including unconsciousness, hypoventilation, and decreased SpO2 (88%), the patient was intubated and mechanically ventilated. On the fourth day after admission, the patient was unresponsive, with no attempt to breath spontaneously. The plasma level of benzodiazepines was 1,772 μg/l. The elimination of benzodiazepines by MARS was attempted, continuing for 5 days, with one session per day. Five sessions of MARS effectively enhanced benzodiazepine elimination. After the first MARS treatment, the plasma level of benzodiazepines dropped from 1,772 to 780 μg/l. After the final MARS treatment on the eighth day, the patient was weaned from mechanical ventilation and extubated. Two days later, the patient was discharged to the internal medicine department and subsequently to the psychiatry department.Conclusions: To the best of our knowledge, this is the first case reporting successful treatment of diazepam intoxication using MARS. In severe cases of diazepam intoxication, with prolonged unconsciousness and the necessity of mechanical ventilation, we suggest considering the use of MARS elimination therapy together with the monitoring of the BDZ plasma level.

Very high-dose methylprednisolone for treatment of nivolumab-induced limbic encephalitis: A case report

2020 ◽  
Vol 26 (6) ◽  
pp. 1538-1543 ◽  
Author(s):  
Vincent-Thierry Taillefer ◽  
Marjorie Pigeon ◽  
Michelle Chen ◽  
Catherine Larochelle ◽  
Marie Florescu ◽  
...  
Keyword(s):  
Case Report ◽  
Limbic Encephalitis ◽  
Oral Prednisone ◽  
Neurological Impairment ◽  
Immune Checkpoint Blockade ◽  
High Dose ◽  
Life Threatening ◽  
Autoimmune Limbic Encephalitis ◽  
High Doses ◽  
Very High

Introduction Nivolumab is a programmed death 1 (PD-1) inhibitor approved by the Food and Drug Administration (FDA) for the treatment of eight different cancers including metastatic melanoma. Immune checkpoint blockade may lead to a range of neurologic immune-related adverse events (irAEs) with severity varying from mild to life-threatening, including encephalitis. Case report We describe a case of a 68-year-old man who developed alteration in mental status, physical weakness and fatigue after nine cycles of nivolumab 3 mg/kg every two weeks. These symptoms were compatible with a clinical diagnosis of autoimmune limbic encephalitis, although no specific antibodies were detected and the initial MRI was normal. Management and outcome The patient received intravenous methylprednisolone 1 g daily for 5 days, which was then converted to a maintenance dose of oral prednisone. The patient made a full clinical recovery but relapsed clinically upon steroid tapering, while hypersignal in the left mesial temporal suggestive of limbic encephalitis was observed on repeated MRI. Discussion Because of the prevailing usage of nivolumab in many cancer protocols, this case highlights the importance of rapidly recognising neurological impairment in patients treated with nivolumab and of initiating very high doses of corticosteroids.

Acute cerebellar toxicity induced by high dose of cytarabine (HiDAC): A case report

2020 ◽  
Vol 26 (6) ◽  
pp. 1492-1494 ◽  
Author(s):  
Hamid Rahmani ◽  
Mojan Radmehr ◽  
Molouk Hadjibabaie ◽  
Mohammad Solduzian
Keyword(s):  
Acute Myeloid Leukemia ◽  
Case Report ◽  
Side Effects ◽  
Myeloid Leukemia ◽  
High Dose ◽  
High Dose Cytarabine ◽  
Pyrimidine Analogue ◽  
High Doses ◽  
Different Doses ◽  
Acute Myeloid

Cytarabine is a pyrimidine analogue that is used for the treatment of acute myeloid leukemia at different doses. Standard doses of cytarabine are used for induction therapy, while high doses are used for post-remission (consolidation) and relapsed/refractory treatment. One of the major side effects of its high doses is acute cerebellar toxicity occurring in 10 to 25% of patients. We report a case that developed this side effect after receiving two doses of high-dose cytarabine. The patient’s symptoms improved after withholding the drug. Thereafter, the patient tolerated treatment continuation with lower doses.

scholarly journals Treatment of Tetanus in ICU: A Case Report

2013 ◽  
Vol 1 (1) ◽  
pp. 56-58
Author(s):  
Farzana Shumy ◽  
Ahmad Mursel Anam ◽  
Mohammad Mafizul Islam Polash ◽  
Md Motiul Islam ◽  
Raihan Rabbani ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Developing Countries ◽  
Case Report ◽  
Cause Of Death ◽  
Muscle Relaxant ◽  
Muscle Spasm ◽  
Depression Treatment ◽  
High Dose ◽  
Respiratory Complications ◽  
High Doses

Tetanus remains an important cause of death in the developing countries, like Bangladesh. The cause of death in tetanus is spasm of the larynx and muscle spasm. High dose muscle relaxant are required to prevent this which itself has side effect like respiratory depression. Treatment in ICU with the help of mechanical ventilation prevents death from respiratory complications and produce best possible therapeutic effect of the drugs. In this case, a patient of tetanus was managed in ICU with high doses of muscle relaxant along with all the medication necessary for tetanus and produced good outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14372 Bangladesh Crit Care J March 2013; 1: 56-58

Higher naloxone dosing may be required for opioid overdose

2019 ◽  
Vol 76 (22) ◽  
pp. 1835-1837 ◽  
Author(s):  
Russell Bardsley
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
New Hampshire ◽  
Community Hospital ◽  
High Dose ◽  
Opioid Overdose ◽  
Small Community ◽  
Emergency Personnel ◽  
High Doses ◽  
Small Community Hospital

Abstract Purpose Carfentanil is a synthetic opioid with an estimated potency that is 10,000 times more than that of morphine and 100 times more than that of fentanyl. Although there is a paucity of evidence, when considering the potency of carfentanil, it is reasonable to speculate that larger doses of naloxone may be required to resuscitate patients after carfentanil ingestion. This case report discusses the use of high-dose naloxone in 2 patients with suspected carfentanil overdose presenting to a small community hospital. Summary Two patients with suspected carfentanil overdose presented to a 30-bed emergency department at a community hospital in New Hampshire. Cyanosis and respiratory distress were noted in both instances, and airway intervention was ultimately deemed necessary. Patient 1 required a total of 12 mg of naloxone to be successfully resuscitated, while patient 2 required a total of 10 mg for resuscitation. Both patients were successfully resuscitated with high doses of naloxone. The use of high-dose naloxone prevented the need for intubation in these patients. Conclusion While more robust studies should be considered, emergency personnel should be comfortable using higher-than-standard doses of naloxone in appropriate cases.

High-dose fentanyl dependence: a case report

Ból ◽  
2021 ◽  
Vol 21 (4) ◽  
pp. 48-53
Author(s):  
Michał Kurek ◽  
Izabela Kurek ◽  
Tadeusz Nasierowski ◽  
Małgorzata Malec-Milewska
Keyword(s):  
Chronic Pain ◽  
Case Report ◽  
Adverse Effects ◽  
High Dose ◽  
High Doses

Usage of opioids in chronic pain may cause many adverse effects. One of them is a risk of addiction. We would like to present a case report of detoxification of a 76-years old patient. She was addicted to high doses of fentanyl (totally 14400 μg fentanyl per day – 400 μg/h in transdermal system and 12 transmucosal pills per day).

The Influence of Serotonin on Clot Retraction and the Thrombelastogram

1958 ◽  
Vol 02 (01/02) ◽  
pp. 111-124 ◽  
Author(s):  
E Deutsch ◽  
K Martiny
Keyword(s):  
Human Plasma ◽  
Human Platelet ◽  
Platelet Rich Plasma ◽  
Specific Effect ◽  
High Dose ◽  
Clot Retraction ◽  
Platelet Counts ◽  
Essential Value ◽  
High Doses ◽  
Free Plasma

Summary1. Normal platelets are necessary for induction of normal clot retraction.2. Serotonin does not induce retraction in human platelet-free plasma-clots or enhance clot firmness as measured in the coagulogram.3. Serotonin does not improve clot retraction or firmness in plasma clots with sub-optimal platelet counts.4. Methylserotonin inhibits clot retraction of platelet-rich plasma to a certain extent in moderate doses, whereas, high doses are ineffective. BOL 148 has a similar, but less significant action. There is a possibility that these effects are specific antiserotonin-effects.5. LSD 25 was ineffective in all concentrations used.6. Largactil and reserpin inhibit retraction in high doses. There seems to be a non specific effect caused by the high dose.7. Reserpine does not release a retraction-inducing agent from the platelets, which could be detected in the centrifuged platelet-free plasma used for the incubation.8. Serotonin does not replace the retraction-cofactor of Hartert, or the dialyzable factor of Lüscher in synthetic clotting substrates.9. Serotonin is of no essential value in inducing normal retraction of human plasma clots.

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