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Naloxone/oxycodone Acute toxic leucoencephalopathy, other toxicities and lack of efficacy: case report

A 57-year-old woman developed acute toxic leucoencephalopathy, hypoxia, liver dysfunction and renal dysfunction following an intentional oxycodone overdose. Additionally, she exhibited lack of efficacy during treatment with naloxone for oxycodone overdose [time to reaction onsets not stated]. The woman, who had a history of type 2 diabetes mellitus, depression and panic attacks, had allegedly taken 14 tablets of 10mg oxycodone. Her only other medication was mirtazapine. Her Glasgow coma scale score was 5/15 (E1V1M3) with hypoxia. She developed liver and renal dysfunction. Urine toxicology screen showed a positive result for opiates. She was diagnosed with oxycodone overdose and was admitted. The woman was intubated and administered naloxone infusion for 48 hours [dosage not stated]. However, no improvement on naloxone was noted. Two days later, a brain CT scan suggested the possibility of global hypoxic brain injury. After 13 days, tracheostomy was performed, and she was transferred to the stroke unit. After reviewing the images, the neuroradiologist confirmed that the findings were consistent with oxycodone overdose. The initial CT scan revealed low attenuation in both globus pallidi (GPa) and cerebellar white matter (WM). Subsequent imaging demonstrated progression of low attenuation with pathologic mass effect, which caused mechanical obstruction to CSF outflow and tonsillar herniation. An interval brain MRI showed the development of GPa and cerebellar injury, which was indicative of an acute toxic leukoencephalopathy secondary to oxycodone overdose. She then underwent a percutaneous endoscopic gastrostomy insertion and tracheostomy decannulation. She became more alert in the next 2 months with significant neurological deficits and continued neurorehabilitation. Jones E, et al. Lesson of the month: Oxycodone-induced leukoencephalopathy: a rare diagnosis. Clinical Medicine (London, England) 20: 600-602, No. 6, Nov 2020. Available from: URL: http://doi.org/10.7861/clinmed.2020-06500-0-0

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Reactions 12 Dec 2020 No. 1834