Gary B Zuckerman

Neurologic complications following intranasal administration of heroin in an adolescent

OBJECTIVE: To describe an adolescent patient who developed a stroke following intranasal administration of heroin. CASE SUMMARY: A 17-year-old adolescent with no prior medical problems “snorted” an unknown quantity of heroin. The patient developed respiratory failure, shock, and seizures. When he regained consciousness, the patient had evidence of hypoxic-toxic encephalopathy on neuropsychologic examination. Magnetic resonance imaging revealed an infarct in the globus pallidus region of the brain. DISCUSSION: Serious neurologic complications following intranasal administration of heroin have been reported rarely in children. Correlations between findings on neuropsychologic examination and magnetic resonance imaging following drug overdoses have likewise been rarely described. We reviewed literature pertaining to the etiology, pharmacology, and pathophysiology of neurologic complications resulting from heroin intoxication. CONCLUSIONS: As the use of intranasal heroin is increasing in the pediatric population, healthcare professionals should be aware of the various potentially serious complications that may occur.

Pulmonary Complications following Tricyclic Antidepressant Overdose in an Adolescent

OBJECTIVE: To report a case of pulmonary edema following a tricyclic antidepressant (TCA) overdose in an adolescent. CASE SUMMARY: A 14-year-old girl with a history of prior suicide attempts ingested 54 50-mg desipramine hydrochloride tablets (45 mg/kg ingestion). The patient developed a cardiac dysrhythmia and hypotension, which were successfully treated. She subsequently developed pulmonary edema and a clinical picture suggestive of adult respiratory distress syndrome (ARDS). She was successfully managed with fluid restriction, tracheal intubation, application of positive end-expiratory pressure (PEEP), and vasopressors. The patient was discharged without any clinical sequelae. DISCUSSION: Pulmonary complications secondary to TCA overdose have rarely been reported in children. We reviewed literature pertaining to the etiology, epidemiology, pathophysiology, and management of TCA-induced lung injury, as well as other case reports. We discuss the potential relationship between sequelae resulting from TCA ingestion (e.g., cardiac disturbances, hypotension, acidosis, gastric aspiration, pneumonia) and the development of ARDS and pulmonary edema, and relate this association to our patient. CONCLUSIONS: Pulmonary edema and a clinical picture suggestive of ARDS was noted in an adolescent girl who ingested a large quantity of desipramine. Her lung injury may have been the result of a variety of factors including hypotension, metabolic acidosis, possible aspiration, or a direct action on the lung parenchyma by desipramine. We attribute her favorable clinical outcome to early intervention consisting of tracheal intubation, PEEP, fluid restriction, and vasopressor therapy.

Neurologic disorders and dermatologic manifestations in HIV-infected children.

Cutaneous manifestations of HIV infections in childhood are common but are not the dermatologic lesions associated with HIV infection in adults. For example, Kaposis sarcoma, a common finding in adults with AIDS, is rare in children. Other cutaneous manifestations, including bacterial and fungal lesions and viral exanthems, are common in children with AIDS and can be atypical and severe. Because 90% of the pediatric AIDS population acquires the virus via maternal transmission to the fetus, a dysmorphic syndrome associated with intrauterine infection has been described. Physicians caring for and evaluating pediatric patients at risk for AIDS should be aware of these dermatologic manifestations, so that early detection and treatment can be instituted to reduce the morbidity of the complication of HIV infection.