Alprazolam/antidepressants/opioid analgesics overdose
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Hypoxia leading to delayed leukoencephalopathy: 3 case reports Two men and one woman developed hypoxia leading to reversible delayed posthypoxic leukoencephalopathy following an overdose of alprazolam, amitriptyline, trazodone, fentanyl and/or oxycodone [amounts and routes of overdoses not stated; time to reaction onsets not stated]. A 54-year-old man with a history of substance abuse and depression was found in an unresponsive state. During transport to a hospital, he developed respiratory arrest and was intubated. He was admitted, and blood gas analysis revealed profound acidaemia, while a drug screen revealed alprazolam, oxycodone and cocaine. He subsequently developed aspiration pneumonia. He received antibacterials and supportive care, and was discharged with baseline neurological status 12 days after the overdose. Seventeen days after overdose, he was found disorientated and unable to follow commands. Neurological examination revealed agitation, disfluent language and impaired orientation. His clinical status subsequently deteriorated, with an inability to speak or follow commands, and increasing somnolence. An EEG at 22 days after overdose revealed generalised slowing. A repeat MRI 38 days after overdose revealed extensive T2 prolongation and restricted diffusion throughout the periventricular and subcortical white matter. MR spectroscopy of the white matter revealed a decreased Nacetyl-aspartate level and an increased choline-creatine ratio. He continued to receive supportive care and treatment for depression and substance abuse. At 6 months after the overdose, he had returned to his neurological baseline, while an MRI revealed resolution of restricted diffusion, with mild residual areas of T2 prolongation. A 59-year-old man with a history of substance abuse was found unresponsive at home with a decreased respiratory rate. He was intubated and transported to hospital. Blood gas analysis revealed respiratory acidosis consistent with prolonged hypoxia, while a drug screen revealed alprazolam, fentanyl and an elevated blood alcohol level. Within 24 hours of hospitalisation, he was extubated with baseline neurological status. He subsequently developed myocardial infarction and aspiration pneumonia, and required treatment. He also developed rhabdomyolysis resulting in acute renal failure and required haemodialysis. An MRI at 16 days after admission revealed areas of hyperintensity and mild chronic periventricular ischaemic white matter changes. At 24 days after overdose, he developed agitation, cognitive slowing and impaired speech and memory. An MRI 28 days after overdose revealed new extensive T2 prolongation through the periventricular and subcortical white matter with restricted diffusion. He received supportive care and treatment, and his cognitive impairment slowly resolved. At 3 months after overdose, he had residual short-term memory problems and impaired judgement and executive functioning. A follow-up MRI at 6 months after overdose revealed decreased T2 prolongation. A 46-year-old woman, who had a
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