Pneumotox » Drug » Heroin (inhaled, insufflated, snorted)

Heroin (inhaled, insufflated, snorted)

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Recent data indicate that heroin may be laced with fentanyl, potentially causing ventilatory depression that can be fatal (PMID 25869219)

Last update : 11/02/2019

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

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I.b Pneumonitis (ILD)

1

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

I.e Acute eosinophilic pneumonia (AEP)

1

II.a Pulmonary edema, noncardiogenic (NCPE)

1

II.d Pulmonary edema, cardiogenic

1

IV.a Bronchospasm - Wheezing - Asthma

3

IV.f Severe or catastrophic bronchospasm or asthma attack (can be fatal)

3

IV.n Obstructive airway dysfunction (see also IVc, XVx)

2

IV.o Airway hyperresponsiveness

2

V.f Pneumothorax

1

IX.t CNS involvement/dysfunction/damage

1

XI.m Pulmonary emphysema - Lung cysts or bullae

1

XII.f Cardiomyopathy (acute, subacute, chronic)

1

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

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Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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