METHADONE OVERDOSE-INDUCED TORSADE DE POINTES IN A HIV-POSITIVE PATIENT – A RARE CASE REPORT

Cristian Cobilinschi; Radu Tincu; Andrei Radu; Bianca Machedon; Denisia Dabija; Claudia Cobilinschi; Ioana Marina Grințescu

doi:10.33695/rjcr.v5i1.77

Cristian Cobilinschi Anaesthesiology and Intensive Care Unit, Bucharest Clinical Emergency Hospital & Department of Anaesthesiology and Intensive Care – II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Radu Tincu Anaesthesiology and Intensive Care Unit, Bucharest Clinical Emergency Hospital & Department of Toxicology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Andrei Radu Department of Cardiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Cardiology Unit, Bucharest Clinical Emergency Hospital
Bianca Machedon Anaesthesiology and Intensive Care Unit, Bucharest Clinical Emergency Hospital
Denisia Dabija Anaesthesiology and Intensive Care Unit, Bucharest Clinical Emergency Hospital
Claudia Cobilinschi Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Internal Medicine Unit, Sf Maria Clinical Hospital
Ioana Marina Grințescu Anaesthesiology and Intensive Care Unit, Bucharest Clinical Emergency Hospital & Department of Anaesthesiology and Intensive Care – II, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

DOI: https://doi.org/10.33695/rjcr.v5i1.77

Keywords: methadone, prolonged QT interval, torsade de pointe, arrythmia, cardiac toxicity

Abstract

Methadone belongs to the opioid class, being a synthetic compound that can be used as a replacement drug in heroin addicted patients. Patients on methadone can present with prolonged QT interval but progression to torsade de pointes (TdP) is highly uncommon. The aim of this report is to describe methadone-induced torsade de pointes in a HIV-positive patient. Case presentation. A 28-year old male taking methadone as substitution therapy was brought in the emergency department after purposely overdosing. On admission his hemodinamical and respiratory parameters were stable. Toxicology samples showed a urinary methadone level of 501 µg/l and a plasma level of 247 µg/l. Intensive care support was started. Soon after admission the EKG trace recorded short bygeminism aspect followed by torsade de pointes. The patient spontanenously converted to sinus rhythm with no need for resuscitation maneuvers. He maintained polymorphic arrythmic tracing that resolved with lidocaine 1% administration. Dynamical determinations showed a gradual decrease in plasmatic and urinary methadone levels, while QT interval became normal. Even though TdP is not commonly met in methadone users, this adverse event should not be overlooked since it has fatal potential. Regular cardiological evaluation and exclusion of additional risk factors are mandatory.

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