Intra-Arterial Self-Injection of Methadone Tablets Into the Femoral Artery

• Published in: The Journal of emergency medicine Vol. 39; no. 3; pp. e125 - e127
• Main Authors: Gramenz, Paul, MD, Roberts, David, MD, Schrag, Laura, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2010
• Subjects: Adult; Emergency; Femoral Artery; Humans; Injections, Intra-Arterial; intra-arterial; Ischemia - chemically induced; Male; methadone; Methadone - administration & dosage; Methadone - adverse effects; Narcotics - administration & dosage; Narcotics - adverse effects; rhabdomyolysis; Rhabdomyolysis - chemically induced; self-injection; Tablets; toxicology; toxicology; self-injection; rhabdomyolysis; methadone; intra-arterial
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2008.08.003

Abstract Background: Accidental intra-arterial (IA) injection of a drug of abuse is a rare but potentially limb-threatening occurrence that causes rhabdomyolysis and limb ischemia through a number of mechanisms. Methadone tablets contain microcrystalline cellulose, which has been shown to cause gangrene in animal studies. Objectives: We present a case of IA injection of methadone tablets dissolved in water, followed by a brief review of the literature. Case Report: A former heroin abuser presented to the Emergency Department after injecting 10 10-mg methadone tablets dissolved in water into his femoral artery. He had severe pain and cyanosis of his leg. Laboratory data revealed a creatine kinase (CK) of 4208. He was started on heparin, low molecular-weight dextran, decadron, sodium bicarbonate, and intravenous dilaudid. An angiogram showed distal small particle embolization and focal areas of spasm. He was discharged on hospital day 6 with patchy mottling throughout the lower extremity and a CK of 30,000. He was treated with nifedipine, enoxaparin, and Coumadin, as well as pain medications. Conclusion: We report a case of IA injection of methadone into the femoral artery causing limb ischemia and rhabdomyolysis. This patient responded to medical therapy.