Opiate Toxicity

Related Subjects: |Metabolic acidosis |Aspirin or Salicylates toxicity |Ethylene glycol toxicity |Renal Tubular Acidosis |Lactic acidosis |Tricyclic Antidepressant Toxicity |Opiate Toxicity |Carbon monoxide poisoning |Benzodiazepine Toxicity |Paracetamol (Acetaminophen) toxicity

Opiate reversal can cause Myalgia, Vomiting, Yawning, Chills, Diarrhoea. In those on End of life care give very small doses of naloxone if concerned about opiate toxicity.

About

• Commonly used both medically and illegally
• Accidental overdose is common as increasing doses needed
• Naloxone is an opiate antagonist which you need to know to use

Clinical

• Drowsiness, coma, Pinpoint pupils
• Needle marks, poor IV access, Respiratory depression
• Mild hypotension, agitation, even seizures but rare

Investigations

• FBC, U&E, ABG, ECG
• May need CXR if signs of sepsis or chest infection
• CT head if the cause of reduced GCS unclear
• Check Paracetamol and Salicylates if possible mixed overdose

Management

• Supportive: ABC's and high flow O2. Close monitoring. Recovery position
• Check ABGs. Consider NP airway if needed. May need HDU and /or Intubation and ventilation
• First try Naloxone 0.4 (400 mcg) - 2 mg (2000 mcg) IV or IM.
• Excessive Naloxone may cause HTN, arrythmias, pulmonary oedema, cardiac arrest.
• As the half-life of naloxone is short an IV infusion may be needed - see link below
• In those likely to abscond or where IV access difficult IM naloxone

References

• Opiate toxicity online reference