Q J Med 2009; 102:357 doi:10.1093/qjmed/hcn151
Advance Access publication 21 November 2008
Clinical picture Haemodynamic changes in acute opiate withdrawal Comparative brachial and central aortic haemodynamic parameters have not been previously reported in opiate withdrawal. A 26-year-old female (BMI 18), presented in severe acute withdrawal due to the ingestion of buprenorphine 12 h after a large dose of heroin. She had ingested 100 mg clonidine 1 h previously. She was cold, shivering, shaking, had severe abdominal and leg cramps and displayed acute psychomotor agitation and emotional distress. Radial applanation tonometry using the Millar—SphygmoCor system was performed, and compared with baseline studies 1 month prior. Peripheral blood pressure increased from 108/57 to 118/79 and central aortic pressure rose from 87/59 to 109/80. The figure shows aortic
systolic pressure and augmentation index in quiescence and withdrawal (A: aortic systolic pressure, control; B: aortic systolic pressure, withdrawal; C: augmentation index, control; D: augmentation index, withdrawal). Her vascular age rose from 20 to 27 years. These haemodynamic changes are dramatic, inform medical treatment and suggest that dynamic arterial function may be an important and previously unrecognized player in addiction and withdrawal. Photograph and text from: Dr A. Stuart Reece, Southcity Family Medical Centre and University of Queensland Medical School, 39 Gladstone Rd., Highgate Hill, Queensland 4101, Australia. email:
[email protected]
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