Naloxone Induced Flash Pulmonary Edema: A Case Report

We present the case of a 26 year old patient with a medical history significant for mild intermittent asthma that developed marked respiratory distress after naloxone administration. EMS was called to the patient’s home after the patient was found unresponsive there. She later endorsed taking a single Ecstasy pill which she had obtained off the street. The patient had an initial excellent response to naloxone, demonstrating a rapid return to her baseline mental status. Within the hour however she developed profound hypoxia, tachypnea, and tachycardia with evidence of acute pulmonary edema on chest x-ray and bedside ultrasound. Her clinical deterioration led to intubation and later ECMO cannulation, however she was eventually discharged home in stable condition after an approximately 3.5 week hospital course. We believe the patient’s presentation is best explained by naloxone induced pulmonary edema, a phenomenon that has been described in the literature previously. However, her preceding ingestion, delayed development of profound cardiomyopathy, and sputum cultures positive for S. pneumoniae provide a broad differential for the patient’s dramatic presentation. Keywords: Naloxone; acute respiratory distress syndrome; toxic overdose; ECMO