Naloxone-responsive encephalopathy in end-stage renal disease.
We report the case of a 61-year-old diabetic woman with end-stage renal disease who was on hemodialysis and who developed an encephalopathy and episodes of hypotension and hypoventilation, all of which showed rapid and dramatic responses on multiple occasions to the administration of the opiate antagonist naloxone. Improvement in encephalopathy was confirmed by electroencephalography. The patient had received no exogenous opiates and had a normal beta-endorphin level. She subsequently developed myoclonus and was treated for possible aluminum overload that was of borderline magnitude. We conclude that this patient had an encephalopathy that responded to opiate receptor blockade. Because of cerebrovascular disease, episodes of diminished blood pressure due to a state of increased opiate receptor stimulation may have unmasked this underlying encephalopathy. These effects may have been secondary to increased opiate-binding sites or to elevated central nervous system levels of endogenous opiates.
Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY.
J
J
Mattana
J
J
Ahn
L
L
Desroches
S
S
Fitzmaurice
P C
PC
Singhal
D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects
D009270:Naloxone