TY  - JOUR
PY  - 2011//
TI  - Lethal morphine intoxication in a patient with a sickle cell crisis and renal impairment: Case report and a review of the literature
JO  - Human and experimental toxicology
A1  - Lagas, Jurjen S.
A1  - Wagenaar, Jiri F. P.
A1  - Huitema, Alwin D. R.
A1  - Hillebrand, Michel Jx
A1  - Koks, Cornelis Hw
A1  - Gerdes, Victor Ea
A1  - Brandjes, Desiderius P. M.
A1  - Beijnen, Jos H.
SP  - 1399
EP  - 1403
VL  - 30
IS  - 9
N2  - Morphine-6-glucuronide, the active metabolite of morphine, and to a lesser extent morphine itself are known to accumulate in patients with renal failure. A number of cases on non-lethal morphine toxicity in patients with renal impairment report high plasma concentrations of morphine-6-glucuronide, suggesting that this metabolite achieves sufficiently high brain concentrations to cause long-lasting respiratory depression, despite its poor central nervous system penetration. We report a lethal morphine intoxication in a 61-year-old man with sickle cell disease and renal impairment, and we measured concentrations of morphine and morphine-6-glucuronide in blood, brain and cerebrospinal fluid. There were no measurable concentrations of morphine-6-glucuronide in cerebrospinal fluid or brain tissue, despite high blood concentrations. In contrast, the relatively high morphine concentration in the brain suggests that morphine itself was responsible for the cardiorespiratory arrest in this patient. Given the fatal outcome, we recommend to avoid repeated or continuous morphine administration in renal failure.<p />  <p>Language: en</p>
LA  - en
SN  - 0960-3271
UR  - http://dx.doi.org/10.1177/0960327110388962
ID  - ref1
ER  -