Titre du document / Document title

Near fatal intoxication with controlled-release morphine tablets in a depressed woman

Auteur(s) / Author(s)

WESTERLING D. ⁽¹⁾ ; SÄWE J. ⁽²⁾ ; EKLUNDH G. ⁽³⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Anesthesiology and Intensive Care, Lund University Hospital, Lund, SUEDE
⁽²⁾ Department of Clinical Pharmacology at the Karolinska Institute, Huddinge University Hospital, Huddinge, SUEDE
⁽³⁾ Department of Internal Medicine, Lund University Hospital, Lund, SUEDE

Résumé / Abstract

Background: A 46-year-old woman suffering from a reactive depression was admitted to the emergency room in coma and with severe respiratory failure. She later developed cardiovascular instability and general convulsions. Two days following admission the patient had no respiratory effort but was able to communicate in writing that she had ingested a large amount of controlled-release morphine tablets. Following treatment with naloxone she was successfully weaned from the respirator the next day. Methods: Sampling for determination of plasma and urine concentrations of morphine and its metabolites morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) was started 60 h after the presumed time of intake and continued up to 8 days after admission. Results: The initial plasma concentrations of morphine, M3G and M6G were 2160, 13100 and 2330 nM, respectively, compatible with a lethal dose in an opioid-naive patient. The urinary recovery of morphine, M3G and M6G corresponded to 6.8 mmol, equivalent to an oral intake of at least 2500 mg. Conclusion: The plasma concentrations of morphine and morphine metabolites documented in this case, indicative of considerable absorption of drug, demonstrate that prolonged observation is necessary following intoxications with controlled-release morphine tablets. This case also highlights the importance of continuous follow-up of oral morphine therapy, so that unused drug is not left unaccounted for in the patient's home.

Revue / Journal Title

Acta anaesthesiologica scandinavica   ISSN 0001-5172   CODEN AANEAB 

Source / Source

Congrès
Joint meeting of neuroanaesthesia societies of Finland, Scandinavia, Great Britain, and Ireland, Helsinki , FINLANDE (22/05/1998)
1998, vol. 42, n^o 5, pp. 601-606 (22 ref.), pp. 586-589

Langue / Language

Anglais

Editeur / Publisher

Blackwell, Oxford, ROYAUME-UNI  (1957) (Revue)

Mots-clés anglais / English Keywords

Morphine ; Coma ; Respiratory failure ; Convulsion ; Depression ; Controlled release form ; Tablet ; Drug intoxication ; Narcotic analgesic ; Case study ; Human ; Opiates ; Toxicity ; Nervous system diseases ; Neurological disorder ; Consciousness impairment ; Respiratory disease ;

Mots-clés français / French Keywords

Morphine ; Coma ; Insuffisance respiratoire ; Convulsion ; Etat dépressif ; Forme libération contrôlée ; Comprimé ; Intoxication médicamenteuse ; Analgésique narcotique ; Etude cas ; Homme ; Opiacés ; Toxicité ; Système nerveux pathologie ; Trouble neurologique ; Trouble conscience ; Appareil respiratoire pathologie ;

Mots-clés espagnols / Spanish Keywords

Morfina ; Coma ; Insuficiencia respiratoria ; Convulsión ; Estado depresivo ; Forma liberación controlada ; Tableta ; Intoxicación medicamentosa ; Analgésico narcotico ; Estudio caso ; Hombre ; Opiados ; Toxicidad ; Sistema nervioso patología ; Trastorno neurológico ; Trastorno consciencia ; Aparato respiratorio patología ;

Localisation / Location

INIST-CNRS, Cote INIST : 8878, 35400007576417.0160