Key result
Prescription methadone use in a 54-year-old patient with hypokalaemia precipitated prolonged (10 min) ventricular arrhythmias including torsades de pointes and self-terminating VF.
Case Report (n=1)
Highlights the risk of severe ventricular arrhythmias, including torsades de pointes and ventricular fibrillation, in patients taking prescription methadone, especially in the presence of hypokalaemia.
Answers are grounded in this paper and cite their sources.
May warrant electrolyte vigilance with methadone; hypothesis-generating case report requiring prospective confirmation.
Methadone is known to prolong the QT interval and precipitate torsades de pointes. A 54-year-old prescription methadone user with hypokalaemia was referred to Critical Care with acute confusion and respiratory distress. Alcohol withdrawal was the presumed precipitant. The real precipitant only became evident on analysis of a 24-h ECG (Holter monitor) attached to the patient at the time. The patient had suffered prolonged (10 min) ventricular arrhythmias including torsades de pointes and self-terminating ventricular fibrillation. The patient made a full recovery. Risk factors for acquired long QT syndrome and the treatment of torsades de pointes are discussed.
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Atkinson et al. (2007) conducted a case report in Torsades de pointes and ventricular fibrillation (n=1). Methadone was evaluated. Prescription methadone use in a 54-year-old patient with hypokalaemia precipitated prolonged (10 min) ventricular arrhythmias including torsades de pointes and self-terminating VF.
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