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Case Report
 
Acute opioid detoxification revealing a unique challenge in clinical management
Alexander Sabre1, Lydia Ehlenberger2
1Universidad Autonoma de Guadalajara-Medical Student, Guadalajara, Jalisco, Mexico.
2Pediatrix/Obstetrix Medical Group, Scottsdale Healthcare System, Department of OB/GYN Phoenix, Arizona.

Article ID: 100006CRINTAS2015
doi:10.5348/crint-2015-6-CR-1

Address correspondence to:
Alexander Michael Sabre
2045 S McClintock Dr Apt #233
Tempe, Arizona 85282
USA
Phone: 602-703-7563, 610-746-9642

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How to cite this article:
Sabre A, Ehlenberger L. Acute opioid detoxification revealing a unique challenge in clinical management. Case Rep Int 2015;4:1–5.


Abstract
Introduction: Opioid abuse in pregnancy is inherit to a multitude of adverse outcomes for both mother and fetus, with use of intra-dermal injections for drug delivery leading to systemic sequela such as endocarditis. In patients with history of drug abuse, infective endocarditis most frequently presents as a subacute disease process that requires high clinical suspicion.
Case Report: We report a case of a 21-year-old caucasian female, G3P0020, who presented to the emergency department in a state of acute opioid withdraw. Initial investigation detailed a positive pregnancy test and leukocytosis. The extensive workup revealing a viable embryo and culture negative endocarditis (CNE) with vegetation on tricuspid valve and further care ensuring proper treatment for inpatient course.
Conclusion: We present a clinical case of intravenous-opioid derived CNE composed of challenges that required multiple disciplines and collaboration of multiple specialties in the gravid patient along with detailed information on management in this subset of patients.

Keywords: Endocarditis, Pregnancy, Opioid dependency


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Author Contributions
Alexander Sabre – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lydia Ehlenberger – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Alexander Sabre et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Alexander Sabre is 4th year Medical Student at Affiliated Hospital Scottsdale Healthcare System, Universidad Autonoma de Guadalajara, Guadalajara, Mexico. He earned undergraduate degree (B.S. Biology CMGB) from Drexel University, Philadelpiha, USA and postgraduate degree (Medico Cirujano) from (Universidad Autonoma de Guadalajara, Guadalajara, Mexico). He has published three research papers in national and international academic journals. His research interests include management of obstetric patients, maternal lactation research, importance of preconception follow-up in high-risk pregnancies, endocarditis in the gravid patient, fever of unknown origin, west Nile encephalitis. He intends to pursue a residency in OB and GYN in a program that will provide a solid foundation in general principles that will be important to pursue a fellowship in the field) in the future.



Lydia Ehlenberger is (MD. FACOG) Phoenix Perinatal Associates; OB Hospitalist; Obstetrix, Mednax; Phoenix, AZ, USA. Medical Degree earned at University of Arizona College of Medicine, Tucson, AZ. Board Certified, American Board of Obstetricians & Gynecologists (ABOG). Fellow American College of Obstetricians & Gynecologists (FACOG). Medical Acupuncture for Physician: UCLA Certification. Her research interests include (acupuncture in obstetric patients and congenital anomalies. Her medical mission continues to foster compassion for patients whilst achieving excellence in the high risk OB and GYN specialty. Her future interests include research in Acupunture treatments for the high risk antepartum Obstetric patient. Having recently completed "Medical acupuncture for Physicians:" UCLA certified, She intend to maintain her certification with hopes to create an academic environment in blending evidence based medicine with the daily clinical practice in our high risk antepartum unit, at best we can bridge the gap between the historical paradigms of medicine.




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