Acute Methadone and Cocaine Poisoning Complicated by Cardiac Arrest: Case Report

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Abstract
Objective : to evaluate the effects of correcting metabolic disorders in the post-resuscitation period in a clinical case report. Materials and methods . Management and dynamic monitoring of acute poisoning in a 29-year-old patient after concomitant use of methadone and cocaine complicated by cardiac arrest and prehospital biochemical and acid-base balance alterations. Results . The bradypneic and comatose patient developing out-of-hospital cardiac arrest (OHCA) was hospitalized after effective resuscitation by emergency team. Comprehensive lab examination revealed the presence of methadone and cocaine, decompensated metabolic lactic acidosis and hyperkalemia. Patient’s condition improved after intense correction of metabolic alterations with sodium hydrocarbonate, a glucose-insulin mixture, and a pharmaceutical containing inosine + nicotinamide + riboflavin + succinate. A positive trend including recovered consciousness, switch from ventilator support to spontaneous breathing, and stable hemodynamics was documented after 3 days of treatment. However, emerging complications such as hospital-acquired pneumonia and acute kidney injury had to be managed. The patient improved significantly by the 17th day of treatment, and was discharged on day 21. Conclusion . Intensive care to promptly address decompensated metabolic lactic acidosis (sodium hydrocarbonate, a multi-component drug containing inosine + nicotinamide + riboflavin + succinate) and hyperkalemia (glucose-insulin solution), reduced the severity of metabolic alterations after cardiac arrest due to acute methadone and cocaine poisoning, favoring patient’s outcome.

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