title: Naloxone-reversible coma unrelated to opiate drugs.
abstract: A role for endogenous opioids in central nervous system disorders has often been proposed. A case report is presented of a 47-year-old male, medicated only with carbamazepine and lithium, who developed a precipitous alteration of consciousness (Glascow coma scale = 4). An extensive medical workup did not reveal an underlying cause. He exhibited a graded awakening with two intravenous doses of naloxone, which gradually reversed as the last naloxone dose was eliminated. Immunoassay and thin-layer chromatography of two urine samples (to evaluate the possibility of a medication error, alcohol ingestion, or illicit drug use) revealed only the presence of carbamazepine. A dysregulation of the endogenous opioid system is believed to underlie this episode.
authors.affiliation: Department of Psychiatry, Louisiana State University Medical Center, Shreveport 71130-3932, USA.
authors.forename: H B
authors.initials: HB
authors.lastname: Pinkofsky
authors.forename: J E
authors.initials: JE
authors.lastname: Manno
authors.forename: A
authors.initials: A
authors.lastname: Krause
mesh_terms: D001284:Atrophy; D003128:Coma / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005625:Frontal Lobe / Q000473:pathology; D015600:Glasgow Coma Scale; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009460:Neurologic Examination; D018847:Opioid Peptides / Q000502:physiology
chemical_list: D009292:Narcotic Antagonists; D018847:Opioid Peptides; D009270:Naloxone