Heroin Toxicity Differential Diagnoses
- Author: Rania Habal, MD; Chief Editor: Michael R Pinsky, MD, CM, FCCP, FCCM more...
Differential Diagnoses
- Acute Respiratory Distress Syndrome
- Diabetic Ketoacidosis
- Head Trauma
- Hypercalcemia
- Hypernatremia
- Hyperosmolar Coma
- Hypoglycemia
- Hypothermia
- Injecting Drug Use
- Lactic Acidosis
- Metabolic Acidosis
- Respiratory Failure
- Toxicity, Alcohols
- Toxicity, Barbiturate
- Toxicity, Benzodiazepine
- Toxicity, Clonidine
- Toxicity, Gamma-Hydroxybutyrate
- Toxicity, Phencyclidine
U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Office of Applied Studies. Results from the 2009 National Survey on Drug Use and Health: National Findings. September 2010. Available at http://www.oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.pdf. Accessed January 2011.
United Nations Office on Drugs and Crime. World Drug Report 2009. Available at http://www.unodc.org/documents/wdr/WDR_2009/WDR2009_eng_web.pdf. Accessed December 11, 2009.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). EMCDDA Annual report 2009: the state of the drugs problem in Europe. November 2009. Available at http://www.emcdda.europa.eu/situation/analysis. Accessed December 11, 2009.
Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline].
National Institute for Drug Addiction (NIDA). Research on the Nature and Extent of Drug Use in the United States.
Hoffman RS, Kirrane BM, Marcus SM. A descriptive study of an outbreak of clenbuterol-containing heroin. Ann Emerg Med. Nov 2008;52(5):548-53. [Medline].
Sporer KA, Dorn E. Heroin-related noncardiogenic pulmonary edema : a case series. Chest. Nov 2001;120(5):1628-32. [Medline].
Atypical reactions associated with heroin use--five states, January-April 2005. MMWR Morb Mortal Wkly Rep. Aug 19 2005;54(32):793-6. [Medline].
Bikell WH, Benar O. Life-threatening opioid toxicity. Prob Crit Care. 1987;1:106.
Bryant WK, Galea S, Tracy M, et al. Overdose deaths attributed to methadone and heroin in New York City, 1990-1998. Addiction. Jul 2004;99(7):846-54. [Medline].
Buajordet I, Naess AC, Jacobsen D, et al. Adverse events after naloxone treatment of episodes of suspected acute opioid overdose. Eur J Emerg Med. Feb 2004;11(1):19-23. [Medline].
Coffin PO, Galea S, Ahern J, et al. Opiates, cocaine and alcohol combinations in accidental drug overdose deathsin New York City, 1990-98. Addiction. Jun 2003;98(6):739-47. [Medline].
Darke S, Hall W, Weatherburn D, et al. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. Apr 1 1999;54(2):155-61. [Medline].
Darke S, Zador D. Fatal heroin 'overdose': a review. Addiction. Dec 1996;91(12):1765-72. [Medline].
Davidson PJ, McLean RL, Kral AH, et al. Fatal heroin-related overdose in San Francisco, 1997-2000: a case for targeted intervention. J Urban Health. Jun 2003;80(2):261-73. [Medline].
Davoli M, Perucci CA, Forastiere F, et al. Risk factors for overdose mortality: a case-control study within a cohort ofintravenous drug users. Int J Epidemiol. Apr 1993;22(2):273-7. [Medline].
Dietemann JL, Botelho C, Nogueira T, et al. [Imaging in acute toxic encephalopathy.]. J Neuroradiol. Sep 2004;31(4):313-26. [Medline].
DOHMH. Investigation into Contaminated Heroin. New York City Department of Health and Mental Hygiene. 2005;Health Alert #6..
Ellenhorn MJ. The Opiates. In: Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning. Baltimore, Md: Lippincott, Williams & Wilkins; 1997:405-447.
Gable RS. Comparison of acute lethal toxicity of commonly abused psychoactive substances. Addiction. Jun 2004;99(6):686-96. [Medline].
Gaeta TJ, Capodano RJ, Spevack TA. Potential danger of nalmefene use in the emergency department. Ann Emerg Med. Jan 1997;29(1):193-4. [Medline].
Garrick TM, Sheedy D, Abernethy J, et al. Heroin-related deaths in Sydney, Australia. How common are they?. Am J Addict. Spring 2000;9(2):172-8. [Medline].
Gossop M, Griffiths P, Powis B, et al. Frequency of non-fatal heroin overdose: survey of heroin users recruited innon-clinical settings. BMJ. Aug 17 1996;313(7054):402. [Medline].
Gupta R, Haydock T. Severe hypercapnia caused by acute heroin overdose. Ann Emerg Med. May 2004;43(5):665-6. [Medline].
Gutstein HB, Akil H. Goodman, Gilman, eds. Opioid analgesics. The Pharmacological Basis of Therapeutics. Joel Gri: 2001:569-620.
Handal KA, Schauben JL, Salamone FR. Naloxone. Ann Emerg Med. Jul 1983;12(7):438-45. [Medline].
Hoffman JR, Schriger DL, Luo JS. The empiric use of naloxone in patients with altered mental status: a reappraisal. Ann Emerg Med. Mar 1991;20(3):246-52. [Medline].
Hoffman RS, Goldfrank LR. The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'. JAMA. Aug 16 1995;274(7):562-9. [Medline].
Howland MA. Opioid antagonists. In: Goldfrank LR, Flomenbaum NR, eds. Goldfrank's Toxicologic Emergencies. 8th ed. New York: McGraw-Hill; 2006:614-615.
Hutchins KD, Pierre-Louis PJ, Zaretski L, et al. Heroin body packing: three fatal cases of intestinal perforation. J Forensic Sci. Jan 2000;45(1):42-7. [Medline].
Infante F, Domínguez E, Trujillo D, et al. Metal contamination in illicit samples of heroin. J Forensic Sci. Jan 1999;44(1):110-3. [Medline].
Lewis N. Opioids. In: Goldfrank LR, Flomenbaum NR, eds. Goldfrank's Toxicologic Emergencies. 8th ed. New York: McGraw-Hill; 2006:590-618.
Longo MC, Henry-Edwards SM, Humeniuk RE, et al. Impact of the heroin 'drought' on patterns of drug use and drug-related harms. Drug Alcohol Rev. Jun 2004;23(2):143-50. [Medline].
McCleave NR. Drug smuggling by body packers. Detection and removal of internally concealed drugs. Med J Aust. Dec 6-20 1993;159(11-12):750-4. [Medline].
McLaughlin SA, Richards ME. Another perspective on "Severe hypercapnia caused by acute heroin overdose". Ann Emerg Med. Dec 2004;44(6):670-1; author reply 671-2. [Medline].
Osterwalder JJ. Naloxone--for intoxications with intravenous heroin and heroin mixtures--harmless or hazardous? A prospective clinical study. J Toxicol Clin Toxicol. 1996;34(4):409-16. [Medline].
Richards RG, Reed D, Cravey RH. Death from intravenously administered narcotics: a study of 114 cases;. J Forensic Sci. Jul 1976;21(3):467-82. [Medline].
Ruttenber AJ, Kalter HD, Santinga P. The role of ethanol abuse in the etiology of heroin-related death. J Forensic Sci. Jul 1990;35(4):891-900. [Medline].
Schauben JL. Opioids. In: Irwin RS, Cerra FB, Rippe JM, eds. Irwin and Rippe's Intensive Care Medicine. Baltimore, Md: Lippincott Williams & Wilkins; 1999:1744-1754.
Schwartz JA, Koenigsberg MD. Naloxone-induced pulmonary edema. Ann Emerg Med. Nov 1987;16(11):1294-6. [Medline].
Scopolamine poisoning among heroin users--New York City, Newark, Philadelphia, and Baltimore, 1995 and 1996. MMWR Morb Mortal Wkly Rep. Jun 7 1996;45(22):457-60. [Medline].
Seaman SR, Brettle RP, Gore SM. Mortality from overdose among injecting drug users recently released from prison: database linkage study. BMJ. Feb 7 1998;316(7129):426-8. [Medline].
Smith DA, Leake L, Loflin JR, et al. Is admission after intravenous heroin overdose necessary?. Ann Emerg Med. Nov 1992;21(11):1326-30. [Medline].
Sporer KA. Acute heroin overdose. Ann Intern Med. Apr 6 1999;130(7):584-90. [Medline].
Sporer KA, Firestone J, Isaacs SM. Out-of-hospital treatment of opioid overdoses in an urban setting. Acad Emerg Med. Jul 1996;3(7):660-7. [Medline].
Steentoft A, Kringsholm B, Hansen AC, et al. [Fatal poisonings among drug addicts in Denmark in 2002]. Ugeskr Laeger. May 2 2005;167(18):1954-7. [Medline].
Steentoft A, Worm K, Pedersen CB, et al. Drugs in blood samples from unconscious drug addicts after the intake of an overdose. Int J Legal Med. 1996;108(5):248-51. [Medline].
Sterrett C, Brownfield J, Korn CS, et al. Patterns of presentation in heroin overdose resulting in pulmonary edema. Am J Emerg Med. Jan 2003;21(1):32-4. [Medline].
US Department of Health and Human Services, Substance Abuse and Mental Health. Drug Abuse Warning Network 2003: Interim National Estimates of Drug-Related Emergency Department Visits. December, 2004.
Utecht MJ, Stone AF, McCarron MM. Heroin body packers. J Emerg Med. Jan-Feb 1993;11(1):33-40. [Medline].
Vilke GM, Buchanan J, Dunford JV, et al. Are heroin overdose deaths related to patient release after prehospital treatment with naloxone?. Prehosp Emerg Care. Jul-Sep 1999;3(3):183-6. [Medline].
Washton AM, Resnick RB. Clonidine in opiate withdrawal: review and appraisal of clinical findings. Pharmacotherapy. Sep-Oct 1981;1(2):140-6. [Medline].
Wetli CV, Rao A, Rao VJ. Fatal heroin body packing. Am J Forensic Med Pathol. Sep 1997;18(3):312-8. [Medline].
Wound botulism among black tar heroin users--Washington, 2003. MMWR Morb Mortal Wkly Rep. Sep 19 2003;52(37):885-6. [Medline].
Zador D, Sunjic S, Darke S. Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances. Med J Aust. Feb 19 1996;164(4):204-7. [Medline].

