title: Intra-arterial self-injection of methadone tablets into the femoral artery.
abstract: BACKGROUND
  Accidental intra-arterial (IA) injection of a drug of abuse is a rare but potentially limb-threatening occurrence that causes rhabdomyolysis and limb ischemia through a number of mechanisms. Methadone tablets contain microcrystalline cellulose, which has been shown to cause gangrene in animal studies.
  
  
  OBJECTIVE
  We present a case of IA injection of methadone tablets dissolved in water, followed by a brief review of the literature.
  
  
  METHODS
  A former heroin abuser presented to the Emergency Department after injecting 10 10-mg methadone tablets dissolved in water into his femoral artery. He had severe pain and cyanosis of his leg. Laboratory data revealed a creatine kinase (CK) of 4208. He was started on heparin, low molecular-weight dextran, decadron, sodium bicarbonate, and intravenous dilaudid. An angiogram showed distal small particle embolization and focal areas of spasm. He was discharged on hospital day 6 with patchy mottling throughout the lower extremity and a CK of 30,000. He was treated with nifedipine, enoxaparin, and Coumadin, as well as pain medications.
  
  
  CONCLUSIONS
  We report a case of IA injection of methadone into the femoral artery causing limb ischemia and rhabdomyolysis. This patient responded to medical therapy.
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota 55415, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Gramenz
authors.forename: David
authors.initials: D
authors.lastname: Roberts
authors.forename: Laura
authors.initials: L
authors.lastname: Schrag
mesh_terms: D000328:Adult; D005263:Femoral Artery; D006801:Humans; D007269:Injections, Intra-Arterial; D007511:Ischemia / Q000139:chemically induced*; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects*; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D012206:Rhabdomyolysis / Q000139:chemically induced*; D013607:Tablets
chemical_list: D009294:Narcotics; D013607:Tablets; D008691:Methadone