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Heroin Overdose

Definition

This article describes poisoning from an overdose of heroin.

Poisonous Ingredient

• Heroin

Where Found

Heroin is made by processing opium poppies which are found all over the world.

Symptoms

• Body as a whole
  • Muscle spasticity
• Respiratory
  • Breathing slow and labored
  • Breathing shallow
  • Stopped breathing (sometimes fatal within 2-4 hours)
• Eyes, ears, nose, and throat
  • Extremely small pupils, sometimes as small as the head of a pin ("pinpoint pupils")
  • Dry mouth
  • Tongue discoloration
• Skin
  • Bluish colored fingernails and lips
• Gastrointestinal
  • Spasms of the stomach and/or intestinal tract
  • Constipation
• Heart and blood vessels
  • Weak pulse
  • Low blood pressure
• Nervous system
  • Drowsiness
  • Disorientation
  • Coma
  • Delirium

Home Care

DO NOT INDUCE VOMITING. Call emergency services and Poison Control Center.

Before Calling Emergency

Determine the following information:

• The patient's age, weight, and condition
• The name of the product (ingredients and strengths if known)

Poison Control

They will instruct you if it is necessary to take the patient to the hospital. See Poison Control centers for telephone numbers and addresses. Bring a sample with you to the emergency room if available.

What to Expect at the Emergency Room

Some or all of the following procedures may be performed:

• Administer a laxative
• Give a counteracting drug (narcotic antagonist) -- multiple doses if needed
• Administer intravenous fluids as needed
• Monitor breathing
• Treat the symptoms

Outlook (Prognosis)

If an antidote can be given, recovery from an acute overdose occurs within 24 - 48 hours.

Herpes viral culture of lesion

Viral lesion culture

A viral lesion culture is performed to confirm herpes simplex virus present in a skin lesion. The specimen is collected by scraping the suspected skin lesion or aspirating fluid from the lesion. Results are available within 16 hours to 7 days of receipt of the specimen, depending on the culture method used.

Definition

Herpes viral culture of a lesion is a test to confirm the presence of herpes simplex virus in a skin sore.

How the Test is Performed

A specimen from a skin lesion (often a genital sore) is collected during the acute phase (worst part) of an outbreak and placed in a special substance called medium.

The specimen may be placed in cell cultures, so they can replicate to help identification, or it may be identified by monoclonal antibodies that detect early antigens of herpes simplex virus.

Serotyping of the virus (to determine whether it's type 1 or 2) may also be done. Results are available within 16 hours to 7 days, depending on the culture method used.

How to Prepare for the Test

The specimen must be collected during an acute infection.

How the Test Will Feel

The specimen is collected by scraping the suspected skin lesion or aspirating fluid from the lesion. This can cause a scraping or sticking sensation. Sometimes a specimen from the throat or eyes is obtained, usually by rubbing a sterile swab against the tissues.

Why the Test is Performed

The test is performed to confirm herpes simplex infection. The diagnosis is often made by clinical examination rather than diagnostic testing.

Normal Results

If there is no herpes virus present, none will grow in the culture medium.

What Abnormal Results Mean

Abnormal results may indicate active infection with herpes simplex virus or asymptomatic viral shedding.

Herpes genitalis (genital herpes simplex) is an additional condition under which the test may be performed.

Risks

The risks are slight bleeding or infection at the skin lesion site.

Considerations

Viral culture for herpes is a poor test and is often falsely negative (but extremely rarely falsely positive). That is, even with a negative result, the person could still have herpes.

Newer herpes simplex fluorescent antibody testing may be an alternative. Please consult your doctor.

Urine - Bloody

Female urinary tract

The female and male urinary tracts are relatively the same except for the length of the urethra.

Male urinary tract

The male and female urinary tracts are relatively the same except for the length of the urethra.

Definition

Blood in your urine, or hematuria, can be classified as microscopic or gross.

• Microscopic hematuria is when there is very little blood in the urine and it can only be seen with a microscope.
• Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye. Uusually it turns toilet water pale pink or bright red, or you may just see spots of blood in the water after urinating.

Considerations

In women, blood may appear to be in the urine when it is actually coming from the vagina. In men, what may be mistaken for urinary bleeding is sometimes a bloody ejaculation, usually due to a prostate problem.

Discoloration from certain drugs, beets, or other foods can mimic blood in the urine.

You may not see blood in your urine. In some cases, it is found microscopically when your doctor checks your urine during a routine exam. Your doctor will follow up on this problem to see if it persists and identify the cause.

When blood is visible to the naked eye, prompt and thorough evaluation is always needed. In children, hospitalization is often necessary to complete the work up.

Common Causes

There are many potential causes of blood in the urine. Often, bloody urine is from a problem in your kidneys or other parts of the urinary tract. If your kidneys, urinary tract, prostate, and genitals turn out to be fine, your doctor may check to see if you have a bleeding disorder.

Kidney and urinary tract causes include:

• Cancer of the bladder or kidney
• Fractured pelvis
• Kidney or bladder stones
• Kidney disease following strep throat ( post-stretococcal glomerulonephritis) -- a classic cause of blood in the urine in children
• Kidney failure
• Infection of the bladder, kidney, or urethra
• Inflammation of the bladder, urethra, or kidney ( glomerulonephritis)
• Injury to the kidney
• Polycystic kidney disease
• Recent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsy

Causes from blood disorders include:

• Bleeding disorders (such as hemophilia)
• Blood clot in the kidneys
• Low numbers of platelets
• Medications including blood thinners (such as warfarin)
• Sickle cell disease

Call your health care provider if

Blood in the urine should never be ignored. Tell your doctor about this symptom and get an appropriate evaluation, especially if you have unexplained weight loss, burning with urination, frequent urination, or urgent urination.

Call your doctor right away if:

• You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or back
• You are unable to urinate
• You are passing blood clots

Also call your doctor if:

• You have pain with sexual intercourse or heavy menstrual bleeding -- the problem may be related to your reproductive organs
• You have urine dribbling, nighttime urination, or difficulty starting your urinary flow -- the problem may be related to your prostate

What to expect at your health care provider's office

Your doctor will take a medical history and perform a physical examination. Medical history questions may include:

• When did you first notice blood in your urine?
• What is the underlying color of your urine?
• Do you have any pain with urination?
• Has the quantity of your urine increased or decreased?
• Does your urine have an odor?
• Are you urinating more frequently?
• Do you have an urgent need to urinate?
• What medications are you taking, including over the counter drugs?
• Have you recently eaten foods that may cause discoloration, like beets, berries, or rhubarb?
• Do you have any other symptoms like pain in your back, abdomen, or side? Fever, weight loss, nausea, vomiting, or diarrhea? Nighttime urination? Dribbling? Discharge from penis or vagina? Pain with intercourse?
• Have you had previous urinary problems or kidney problems?
• Do you have any allergies?
• Have you had a recent injury?
• Have you had any recent diagnostic or surgical procedures involving the urinary tract?

Tests that may be done include:

• Abdominal ultrasound
• Blood studies such as a CBC, blood differential, C3, and creatinine
• CT scan of the abdomen
• Cystoscopy
• IVP
• Kidney biopsy
• Kidney x-rays
• Strep test
• Tests for lupus
• Tests for sickle cell, bleeding problems, and other blood disorders
• Urinalysis
• Urine culture
• 24-hour urine collection for creatinine, protein, calcium

The treatment will depend on the cause of the blood in the urine. If a urinary tract infection is confirmed, antibiotics may be prescribed. If appropriate, pain medications will be given.