ivdu
Table of Contents
intravenous drug users (IVDU) or injection drug use (IDU)
introduction
- intravenous drug users are a high risk patient group
- ED issues include:
- drug seeking behaviour
- overdose, particularly, opiates and opioids
- drug toxicity reactions, particularly, Mx of psychostimulant toxicity from amphetamines and related substances
- withdrawal reactions
- transmissible infections such as hepatitis and HIV / AIDS
- drug-induced or exacerbated psychiatric problems including psychoses
- malnutrition
- psychosocial issues
- criminal issues
- septicaemic complications including infective endocarditis (including SBE), and bacterial seeding elsewhere
- foreign body complications such as pulmonary granulomatosis and its complications
- road trauma and legal issues relating to driving whilst intoxicated
- intravenous access issues
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
- mainly in association with HIV / AIDS
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 06:30 by 127.0.0.1