RULE OF DECREASED LEVEL OF GLUCOSE AS A RARE COMPLICATION IN METHADONE TOXICITY WITH LOSS OF CONCISENESS

Background and Aim : Abstract In recent years, methadone poisoning and its derivatives are very harmful, deadly and common in our country and one of the important cause of loss of consciousness, coma, respiratory suppression, apnea and death. We present a 42-year-old man used methadone syrup. The patient came with methadone poisoning symptoms without laboratory finding of hypoglycemia but no dramatic response was observed to naloxone therapy. During the treatment process, a decreased level of glucose was detected and patient dramatically responded to hypertonic glucose. Case presentation We present a 42-year-old is admitted in emergency room with chief complain of loss of conciseness (LOC) (GCS=8/15). He was affected with sever heachache one hour before admission following gradual loss of LOC. He had history of methadone addiction for six years and recent consumption of methadone syrup 2 hours ago. In first exam, he was semi coma with apnostic breathing and cyanosis. In neurologic exam, a miotic and reactive pupil with bilateral upward guaze was reported. Other general (BP: 100/65, RR: 9/min T: 37˚C) and neurologic exam was normal. In paraclinc evaluation, EKG, brain CT and MRI, routine biochemistry parameters were normal [blood glucose (BS) =100]. In toxin screen tests, a positive report for methadone and tramadol were detected. After tracheal intubation and primary stabilization and then naloxone therapy (2mg) with poor response, the patient transferred to toxicology department. We suspected another causes for LOC, and try to rule them out. Again, reevaluated BS with glucometer and it was shown 70mg/dl. Immediately hypoglycemia management was started with hypertonic glucose improving in LOC and the patient was extubated with completely conciseness. After 2 days from admission he was discharged from hospital with normal lab data. Discussion: Naloxone can reversed signs and symptoms of methadone toxicity but in rare condition, decreased level of blood glucose comorbid and confused clinicians in primary treatment. Conclusion: It is necessary to get exact history of patient a complete physical examination and consider hypoglycemia even in LOS in methadone toxicity in order correct diagnosis and treatment.

کلیدواژه ها:

glucose ، methadone ، toxicity