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ivdu

intravenous drug users (IVDU) or injection drug use (IDU)

introduction

pulmonary complications of iv drug abuse

pulmonary infection

  • IVDUs have a 10x risk of community acquired pneumonia
  • tuberculosis (TB) is more prevalent due to poverty, homelessness, malnutrition, HIV / AIDS, and poor medical care
  • septic emboli/infective endocarditis (including SBE) related complications include pulmonary infiltrates, cavities, abscesses, infarction and pulmonary gangrene.

foreign body granulomatosis

  • injection of pulverised tablets as well as filler agents such as talc may lodge in the pulmonary capillaries causing chronic inflammation, granulomata, interstitial fibrosis, emphysema and pulmonary hypertension.

emphysema

  • particularly an issue with HIV / AIDS patients but also with foreign body granulomatosis
  • radiographic incidence of upper lobe bullous lung disease in ivdu's is said to be 2%
  • habitual iv use of methyphenidate has been associated with panlobar emphysema (lower lobes) within 1 to 6 years

pneumothorax

  • may arise from attempts at iv access via subclavian and jugular veins
  • may arise due to septic pulmonary emboli or bullous disease

asthma

  • cocaine and opiate use substantially increases risk of critical attacks of asthma

amyloidosis

acute cocaine specific pulmonary complications

  • regardless of route, cocaine may cause:
    • pulmonary oedema
    • pulmonary haemorrhage
    • bronchiolitis obliterans with organizing pneumonia
    • acute bronchospasm
    • “crack lung” - presumably a hypersensitivity reaction with wheezing, fever, infiltrates, eosinophilia, raised IgE - Rx steroids
ivdu.txt · Last modified: 2011/05/16 16:30 (external edit)