A clinical case of acute methadone poisoning in an infant child

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Abstract

Introduction. The article considers a case of a favorable outcome of severe acute oral methadone poisoning complicated by the development of acute respiratory failure and toxic hypoxic encephalopathy.

Clinical observation. A clinical case of acute oral (through breast milk) methadone poisoning of severe degree in a child of 9 months and 6 days with the development of toxicohypoxic encephalopathy is presented. The narcotic substance entered the body once, after breastfeeding from mother to child. Acute poisoning in the child was manifested by respiratory insufficiency with impaired consciousness (did not respond to pain stimuli, short-term apnea was noted, saturation of arterial blood with oxygen (SpO2) was 62%).

Intensive therapy included infusion, antidote, detoxification therapy, correction of acid-base state disorders, water-electrolyte balance, hypoxic disorders.

Conclusion. Methadone-induced respiratory failure is characterized by dose dependence and the possibility of relief after administration of naloxone.

In our clinical case, a specific antidote was used at the prehospital and hospital stages and an activator of metabolic cellular processes — riboxin in combination with B vitamins: thiamine chloride (vitamin B1) and pyridoxine hydrochloride (vitamin B6).

In conclusion, it should be noted that the relevance of acute methadone poisoning in childhood remains high. Taking into account the mechanisms of the toxic effect of methadone, it is possible to formulate the directions of intensive therapy: maintenance of life support systems, rational antidote therapy, the fight against hypoxia and its consequences.

Compliance with ethical standards. The study was approved by the Local Ethics Committee of the State Budgetary Institution "St. Petersburg Scientific Research Institute of Ambulance named after I.I. Janelidze" Protocol No. 1 of 12.02.2022.

Author contribution:
Narzikulov R.A. — concept and design of the study, collection and processing of material, writing of the text;
Lodyagin A.N. — concept and design of the study, editing;
Sinenchenko A.G., Batotsyrenov Ch.B. — collection and processing of material;
Rustamov B.R., Lisitsyna I.A., Zapadnikov N.D. — writing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Conflict of interest. Authors declare no conflicts of interest in connection with the publication of this article.

Financing. The study had no sponsorship.

Received: April 04, 2023 / Accepted: July 29, 2023 / Published: August 30, 2023

About the authors

Rustam Abdukhalimovich Narzikulov

Leningrad region “Vsevolozhsk Clinical Interdistrict Hospital”; St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Author for correspondence.
Email: rnarzikulov@yandex.ru
ORCID iD: 0000-0002-6788-3050

MD, Senior Researcher of the Department of Clinical Toxicology of the I.I. Janelidze Research Institute of Emergency Medicine, St. Petersburg, 192242, Russian Federation.

e-mail: rnarzikulov@yandex.ru

Russian Federation

Alexey Nikolaevich Lodyagin

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine; Pavlov First St. Petersburg State Medical University

Email: alodyagin@mail.ru
ORCID iD: 0000-0002-8672-2906

Доктор медицинских наук, доцент, руководитель отдела клинической токсикологии ГБУ «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе», 192242, г. Санкт-Петербург, Российская Федерация.

e-mail: alodyagin@mail.ru

Russian Federation

Andrey Georgievich Sinenchenko

St. Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine

Email: andreysin2013@yandex.ru
ORCID iD: 0000-0003-2815-3108

Кандидат медицинских наук, руководитель отдела неотложной психиатрии, наркологии и психореабилитации ГБУ «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И.И. Джанелидзе», 192242, г. Санкт-Петербург, Российская Федерация.

e-mail: andreysin2013@yandex.ru

Russian Federation

Chimit Bairovich Batotsyrenov

Pavlov First St. Petersburg State Medical University

Email: Steelfire@qmail.ru
ORCID iD: 0000-0002-2693-6283

Клинический ординатор кафедры анестезиологии и реаниматологии ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» МЗ РФ, 197022, г. Санкт-Петербург, Российская Федерация.

e-mail: Steelfire@qmail.ru

Russian Federation

Bezhan Rustamovich Rustamov

Pavlov First St. Petersburg State Medical University

Email: frai69729496@mail.ru

Студент лечебного факультета ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. академика И.П. Павлова» МЗ РФ, 197022, г. Санкт-Петербург, Российская Федерация.

e-mail: frai69729496@mail.ru

Russian Federation

Ivan Alexandrovich Lisitsa

Leningrad region “Vsevolozhsk Clinical Interdistrict Hospital”; Federal State budgetary Educational Institution of Higher Education St. Petersburg State Pediatric Medical University of the Ministry of the Russian Federation

Email: ivan_lisitsa@mail.ru

Врач-анестезиолог-реаниматолог ОАР с ПРИТ для взрослого населения ГБУЗ ЛО «Всеволожская межрайонная больница», 188643, Ленинградская область, Российская Федерация; ассистент кафедры общей медицинской практики ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» МЗ РФ, 194100, г. Санкт-Петербург, Российская Федерация.

e-mail: ivan_lisitsa@mail.ru

Russian Federation

Nikita Dmitrievich Zapasnikov

Leningrad region “Vsevolozhsk Clinical Interdistrict Hospital”

Email: zapasnikovnd@vkmb.ru

Заведующий отделением ОАР c ПРИТ для взрослого населения ГБУЗ ЛО «Всеволожская межрайонная больница», 188643, Ленинградская область, Российская Федерация.

e-mail: zapasnikovnd@vkmb.ru

Russian Federation

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Copyright (c) 2023 Narzikulov R.A., Lodyagin A.N., Sinenchenko A.G., Batotsyrenov C.B., Rustamov B.R., Lisitsa I.A., Zapasnikov N.D.


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