Intra-arterial self-injection of methadone tablets into the femoral artery.

Abstract

BACKGROUND:

Accidental intra-arterial (IA) injection of a drug of abuse is a rare but potentially limb-threatening occurrence that causes rhabdomyolysis and limb ischemia through a number of mechanisms. Methadone tablets contain microcrystalline cellulose, which has been shown to cause gangrene in animal studies.

OBJECTIVES:

We present a case of IA injection of methadone tablets dissolved in water, followed by a brief review of the literature.

CASE REPORT:

A former heroin abuser presented to the Emergency Department after injecting 10 10-mg methadone tablets dissolved in water into his femoral artery. He had severe pain and cyanosis of his leg. Laboratory data revealed a creatine kinase (CK) of 4208. He was started on heparin, low molecular-weight dextran, decadron, sodium bicarbonate, and intravenous dilaudid. An angiogram showed distal small particle embolization and focal areas of spasm. He was discharged on hospital day 6 with patchy mottling throughout the lower extremity and a CK of 30,000. He was treated with nifedipine, enoxaparin, and Coumadin, as well as pain medications.

CONCLUSION:

We report a case of IA injection of methadone into the femoral artery causing limb ischemia and rhabdomyolysis. This patient responded to medical therapy.

• Authors: Paul Gramenz, David Roberts, Laura Schrag
• Journal: The Journal of emergency medicine (J Emerg Med) Vol. 39 Issue 3 Pg. e125-7 (Sep 2010) ISSN: 0736-4679 [Print] United States
• PMID: 19150193 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2010 Elsevier Inc. All rights reserved.

Chemical References

• Narcotics
• Tablets
• Methadone

Topics

• Adult
• Femoral Artery
• Humans
• Injections, Intra-Arterial
• Ischemia (chemically induced)
• Male
• Methadone (administration & dosage, adverse effects)
• Narcotics (administration & dosage, adverse effects)
• Rhabdomyolysis (chemically induced)
• Tablets