Opioid antagonists, such as naloxone, also may be administered concurrently with oxygen supplementation. Naloxone works by reversing the effects of hydromorphone, and only is administered in the presence of significant respiratory depression and circulatory depression.Sugar cravings associated with hydromorphone use are the result of a glucose crash after transient hyperglycemia following injection, or a less profound lowering of blood sugar over a period of hours, in common with morphine, heroin, codeine, and other opiates. Hormone imbalance
As with other opioids, hydromorphone (particularly during heavy chronic use) often causes temporary hypogonadism or hormone imbalance. Neurotoxicity
In the setting of prolonged use, high dosage, and/or kidney dysfunction, hydromorphone has been associated with neuroexcitatory symptoms such as tremor, myoclonus, agitation, and cognitive dysfunction. This toxicity is less than that associated with other classes of opioids such as the pethidine class of synthetics in particular. Withdrawal
Users of hydromorphone may experience painful symptoms if the drug is suspended. Some people cannot tolerate the symptoms, which results in continuous drug use. Symptoms of opioid withdrawal are not easy to decipher, as there are differences between drug-seeking behaviors and true withdrawal effects. Symptoms associated with hydromorphone withdrawal include:
Abdominal pain
Anxiety or panic attacks
Depression
Goose bump skin
Inability to enjoy daily activities
Muscle and joint pain
Nausea
Runny nose and excessive secretion of tears
Sweating
VomitingIn the clinical setting, excessive secretion of tears, yawning, and dilation of pupils are helpful presentations in diagnosing opioid withdrawal. Hydromorphone is a rapid acting pain killer; however, some formulations may last up to several hours.
An intraneural perineurioma is a rare benign tumor within the sheath of a single nerve that grows but typically does not recur or metastasize. These lesions are only composed of perineurial cells, cloned from a single cell. They are distinct from schwannoma and neurofibroma. Intraneural perineurioma is a neoplastic proliferation of perineurial cells with unique immunohistochemistry and ultrastructural features, and it is distinct from other onion bulb Schwann cell-derived entities. Despite harboring molecular abnormalities of the long arm of chromosome 22, intraneural perineurioma has not been associated with neurofibromatosis.Due to the involvement of one or more nerve fascicles, intraneural perineuriomas are distinguished by a localized, solitary expansion of peripheral nerves. These tumors develop slowly or stay stable over time. References
Further reading
Macarenco RS, Ellinger F, Oliveira AM (2007). "Perineurioma: a distinctive and underrecognized peripheral nerve sheath neoplasm". Archives of Pathology & Laboratory Medicine. 131 (4): 625–36. doi:10.1043/1543-2165(2007)131[625:PADAUP]2.0.CO;2. PMID 17425397. Kum YS, Kim JK, Cho CH, Kim HK (2009). "Intraneural reticular perineurioma of the hypoglossal nerve". Head Neck. 31 (6): 833–7. doi:10.1002/hed.20965. PMID 18972430. Chung JH, Jeong SH, Dhong ES, Han SK (2014). "Surgical removal of intraneural perineurioma arising in the brachial plexus using an interfascicular dissection technique". Arch Plast Surg. 41 (3): 296–9. doi:10.5999/aps.2014.41.3.296. PMC 4037780. PMID 24883285. Emory TS, Scheithauer BW, Hirose T, Wood M, Onofrio BM, Jenkins RB (1995). "Intraneural perineurioma. A clonal neoplasm associated with abnormalities of chromosome 22". Am J Clin Pathol. 103 (6): 696–704. doi:10.1093/ajcp/103.6.696. PMID 7785653.