VA Morning Report Pearls: A few points on Injection Drug Use

A few points about patient who use injection drugs:

  1. Develop an “Injection Drug Use Review of Systems”  including:
    1. What have been all of your routes of administration (All IV sites, failed IV sites, skin)
    2. Where do you obtain water to use as a diluent?
    3. Do you share needles or do you use clean needles from a needle exchange?
    4. Do you lick your needles?
    5. What, if any, other drugs do you use?
    6. Have you traded sex for drugs?
    7. Do you have access to naloxone? Would you like to have access?
  2. A thorough physical exam of the IDU patient should include evaluation for murmurs but ALSO a careful neuro, skin, and joint exam to look for other sites of metastatic infection.
  3. Injection Drug Use is a risk factor for HIV and HCV so when considering these acute infections remember to send the viral load as well as the antibody test.
  4. After some discussion about CD4 cts in acute illness we asked around and the general teaching is that in acute HIV AND in acute bacterial illness in the setting of chronic HIV the CD4 ct will be ARTIFICALLY LOW.

See you guys in the morning for another great Morning Report!!


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