Annals of Emergency Medicine
Volume 48, Issue 4 , Pages 448-451 , October 2006

Nonketotic Hyperglycemic Coma in Toddlers After Unintentional Methadone Ingestion

  • Sinan Tiras, MD

      Affiliations

    • Intensive Care Unit, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
    • ,
  • Vincent Haas, MD

      Affiliations

    • Intensive Care Unit, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
    • ,
  • Laurent Chevret, MD

      Affiliations

    • Intensive Care Unit, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
    • ,
  • Marion Decobert, MD

      Affiliations

    • Pediatric Emergency Services, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
    • ,
  • Anne Buisine, MD

      Affiliations

    • Biological Toxicology Laboratory, Lariboisière Hospital, Paris, France.
    • ,
  • Denis Devictor, MD

      Affiliations

    • Intensive Care Unit, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
    • ,
  • Philippe Durand, MD

      Affiliations

    • Intensive Care Unit, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
    • ,
  • Pierre Tissières, MD

      Affiliations

    • Intensive Care Unit, Department of Pediatrics, Bicetre Hospital, Le Kremlin-Bicêtre, France
    • Corresponding Author InformationAddress for correspondence: Pierre Tissieres, MD, ICU Laboratory 7-198, Department of Microbiology and Molecular Medicine, University of Geneva Medical School, CMU-Rue Michel-Servet 1, 1211 Geneva 4, Switzerland; +41-22-3795686

Received 16 August 2005 ,Revised 21 February 2006 ,Accepted 22 February 2006.

References 

  1. Harding-Pink D. Methadone: one person’s maintenance dose is another’s poison. Lancet. 1993;341:665–666
  2. Sey MJ, Rubenstein D, Smith DS. Accidental methadone intoxication in a child. Pediatrics. 1971;48:294–296
  3. Aronow R, Paul SD, Woolley PV. Childhood poisoning: an unfortunate consequence of methadone availability. JAMA. 1972;219:321–324
  4. Roxburgh RC, Munro-Faure D. Amidone over dosage in a child. Lancet. 1951;1:174–176
  5. Inselman L. Accidental methadone poisoning. N Engl J Med. 1971;284:1271
  6. Tenenbein M. Continuous naloxone infusion for opiate poisoning in infancy. J Pediatr. 1984;105:645–648
  7. Buchner LH, Cimino JA, Raybin HW, et al. Naloxone reversal of methadone poisoning. N Y State J Med. 1972;72:2305–2309
  8. Lee KD, Lovejoy FH, Haddow JE. Childhood methadone intoxication. Clin Pediatr. 1974;13:66–68
  9. Binchy JM, Molyneux EM, Manning J. Accidental ingestion of methadone by children in Merseyside. BMJ. 1994;308:1335–1336
  10. DiMaio DJ, DiMaio T. Fatal methadone poisoning in children: report of four cases. J Forensic Sci. 1973;18:130–134
  11. Robinson LD, Kwiterovich P, Lietman P, et al. The hazard of narcotics in the home: accidental ingestion by infants and young children. J Pediatr. 1971;79:688–690
  12. Sesso AM, Rodzvilla JP. Naloxone therapy in a seven-month-old with methadone poisoning. Clin Pediatr. 1975;14:388–389
  13. McCurley WS, Tunnessen WW. Methadone toxicity in a child. Pediatrics. 1969;43:90–92
  14. Gayle MO, Ryan CA, Nazarali S. Unusual cause of methadone poisoning. Acta Paediatr Scand. 1991;80:486–487
  15. Watson WA, Litovitz TL, Rodgers GC, et al. 2002 AAPCC annual report. Am J Emerg Med. 2003;21:353–421
  16. Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 AAPCC annual report. Am J Emerg Med. 2004;22:335–404
  17. Sachdeva DK, Stadnyk JM. Are one or two dangerous? (opioid exposure in toddlers). J Emerg Med. 2005;29:77–84
  18. Hickman M, Madden P, Henry J, et al. Trends in drug overdose deaths in England and Wales 1993-98: methadone does not kill more people than heroin. Addiction. 2003;98:419–425
  19. Binchy JM, Molyneux EM, Manning J. Accidental ingestion of methadone by children in Merseyside. BMJ. 1994;308:1335–1336
  20. Bieter RN, Hirsch SA. Methadone in internal medicine. Ann N Y Acad Sci. 1948;51:137–144
  21. Feldberg W, Pyke D, Stubbs WA. Hyperglycaemia: imitating Claude Bernard’s piqure with drugs. J Auton Nerv Syst. 1985;14:213–228
  22. Giugliano D. Morphine, opioid peptides, and pancreatic islet function. Diabetes Care. 1984;7:92–98
  23. Bartlett SE, Dodd PR, Smith MT. Pharmacology of morphine and morphine-3-glucuronide at opioid, excitatory amino acid, GABA and glycine binding sites. Pharmacol Toxicol. 1994;75:73–81
  24. Wolff K. Characterization of methadone overdose: clinical considerations and the scientific evidence. Ther Drug Monit. 2002;24:457–470
  25. Li Y, Eitan S, Wu J, et al. Morphine induces desensitization of insulin receptor signaling. Mol Cell Biol. 2003;23:6255–6266
  26. Backmund M, Meyer K, Zwehl W, et al. myocardial infarction associated with methadone and/or dihydrocodeine. Eur Addict Res. 2001;7:37–39
  27. Devos P, Chiolero R, Van den Berghe G, et al. Glucose, insulin and myocardial ischaemia. Curr Opin Clin Nutr Metab Care. 2006;9:131–139
  28. Cameron FJ, Kean MJ, Wellard RM, et al. Insights into the acute cerebral metabolic changes associated with childhood diabetes. Diabet Med. 2005;22:648–653

 Supervising editor: G. Randall Bond, MDFunding and support: The authors report this study did not receive any outside funding or support.Reprints not available from the authors.

PII: S0196-0644(06)00308-8

doi: 10.1016/j.annemergmed.2006.02.023

Annals of Emergency Medicine
Volume 48, Issue 4 , Pages 448-451 , October 2006

Article Tools