A 20-year-old man is brought to the hospital emergency department by a friend who found him unconscious in his apartment after trying to contact him for 3 days. On arrival, the patient is in a state of respiratory depression. He experiences convulsions for 2 minutes, followed by cardiac arrest. Advanced cardiac life support measures are instituted, and he is stabilized and intubated. On physical examination, there are needle tracks in the left antecubital fossa, miosis, and a loud diastolic heart murmur. His temperature is 39.2deg C. Use of which of the following substances by this man most likely produced these findings?
Heroin is an opiate narcotic that is a derivative of morphine. Opiates are central nervous system (CNS) depressants, and overdoses are accompanied by respiratory depression, convulsions, and cardiac arrest. The typical mode of administration is by injection. An infection, such as endocarditis explaining his heart murmur, often results from such use because the nonsterile injection technique is employed. Cocaine is most often inhaled rather than injected, and acutely produces a state of excited delirium. Ethanol is typically ingested and, in excess, can lead to coma and death. Flurazepam is most often ingested; excessive use can lead to respiratory depression. Meperidine is an analgesic that can cause respiratory depression and bradycardia in overdosage. Phencyclidine (PCP) is a schizophrenomimetic and is usually ingested; users have a history of erratic behavior. Lysergic acid (LSD) is a hallucinogen.
Cocaine
Ethanol
Flurazepam
Heroin
Environment & Nutritional Pathology