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Extra resources for Acute Drug Abuse Emergencies. A Treatment Manual
These p a t i e n t s need close observation and particularly careful m a n a g e m e n t . 4. FEVER In this setting fever m a y have etiologies as disparate as malaria, endocarditis and p y r o g e n reactions. A careful fever w o r k u p is indicated. Prophylactic antibiotics should n o t be used. METHOD OF MARK H. GREENE A N D ROBERT L. DUPONT 31 5. OLIGURIA An unusual cause of oliguria in this setting m a y b e b l a d d e r dysfunc tion secondary t o a c u t e transverse myelitis ( R i c h t e r and Rosenberg, 1968).
T h e r a p y m u s t therefore be directed at respiratory s u p p o r t and an a t t e m p t t o reverse t h e CNS effects of t h e h e r o i n . Sufficiently large doses of heroin can p r o d u c e extensive peripheral vasodilation and h y p o t e n s i o n . Circulatory s u p p o r t m a y be required. Finally, heroin p r o d u c e s a m a r k e d decrease in gastric motility and a m a r k e d increase in antral t o n e . T h e resulting delay in gastric e m p t y i n g makes lavage a w o r t h w h i l e maneuver if t h e r e is evidence of recent ingestion of o t h e r drugs (Dimijian a n d Radelat, 1 9 7 2 ) .
A large bore t u b e should be utilized and t h e c o n t e n t s saved for l a b o r a t o r y e x a m i n a t i o n . This is particularly i m p o r t a n t w h e n t h e precise diagnosis is in d o u b t and w h e n m e t h a d o n e i n t o x i c a t i o n is suspected of being c o m p l i c a t e d by a n o t h e r drug poisoning w h e r e gastric lavage is indicated for diagnostic a n d / o r t h e r a p e u t i c reasons. W h e n lavage is c o m p l e t e d , 100 gm of d r y , p o w d e r e d , activated charcoal ( U S P ) should be suspended in six o u n c e s of w a t e r t o form a paste w h i c h can METHOD O F STUART L.
Acute Drug Abuse Emergencies. A Treatment Manual by M.D. Peter G. Bourne