Methadone
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Multiple toxicities secondary to methadone toxicity: 2 case reports. In a case report of 2 siblings, a 4-year-old boy developed cardiopulmonary arrest, QTc interval prolongation and hyperthermia, and a 2-year-old girl developed cardiopulmonary arrest and sinus tachycardia secondary to methadone toxicity. The boy was brought to emergency department (ED), where he was found to be in acute cardiopulmonary collapse at triage. He had no signs of trauma, so toxicity was strongly suspected. Parents found him unresponsive and was unable to recall precise time. Chest compression was initiated. He had no vital signs and was in asystole with non-reactive, pin-point pupils. Subsequently, he was intubated. After 3 doses of epinephrine [adrenaline], he had a return of spontaneous circulation (ROSC), but had hypotension. The point-of-care micro-electrolytes with glucose and first blood gas revealed pH 6.807, pressure of carbon dioxide (pCO2) 110.2mm Hg, partial pressure of oxygen (pO2) 42mm Hg, base excess in the extracellular fluid (BEecf) 17 mmol/L, bicarbonate (HCO3) 17.4 mmol/L, sodium (Na) 141 mmol/L, potassium (K) 4.8 mmol/L, Ca 1.15 mmol/L, haematocrit 38% and glucose 11.1 mmol/L. Meanwhile, urine and blood were sent for analysis. An ECG after the ROSC revealed relative bradycardia suggesting sodium channel blockade. His QT interval by Barretz formula was 413.7sec. He was treated with sodium bicarbonate and appeared to have narrow the QRS complex. He received 4 doses of sodium bicarbonate. An ECG showed narrow QRS complex
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