Narcotic (Opioid) Overdose.

   

    
The global prevalence of opiate (heroin and opium) use was estimated at 0.4% of the population, or 12.8-20.2 million people ( the United Nations Office on Drug and Crime(UNODC)).  From 2004 to 2011 medical use of opioids increased 100%; use of codeine decreased 20% (ARCOS).

 Receptors and main effects of opioids:

opioid receptors






Symptoms and signs:

Clinical triad: 
1. Central nervous system depression
2. Respiratory depression
3. Pupillary miosis ("pinpoint" pupils):



Other symptoms include: 
  1. Ventricular arrhythmias
  2. Seizures
  3. Nausea
  4. Vomiting
  5. Flushing
  6. Pruritus
  7. Constipation


Diagnostic tests:
  • Drug screens (urine up to 36-48 hours);
  • Basic blood and urine tests ( Complete blood cell count, Metabolic panel, Creatine kinase level, Arterial blood gas determinations, Urine tests);
  • Instrumental studies  (chest, abdomen radiographs for swallowed drug packages);
  • Electrocardiography (ST abnormalities (19%), QTc prolongation (13%), tall R- and/or S-waves (11%) and missing R progression (10%);
  • Echocardiography.


Management:


  • Airways control (Endotracheal intubation in case of patients unability to protect their airways) and cardiopulmonary resuscitation measurements;
  • NALOXONE Administration:
  1. Adults
    1. Initial
      1. No respiratory depression: 0.1 to 0.4 mg IV or IM
      2. Respiratory depression: 1 to 2 mg IV or IM
    2. Next, if no response or incomplete response
      1. Give 2 mg IV or IM every 3-5 minutes to a total of 10-20 mg
    3. Infusion
      1. Naloxone 2 mg in 500 ml D5W or NS (0.004 mg/ml) titrating to response
  2. Children
    1. Initial
      1. No respiratory depression: 0.01 mg/kg IV or IM
      2. Respiratory depression: 0.1 mg/kg IV or IM
    2. Next, if no response or incomplete response
      1. Give 0.1 mg/kg IV or IM.
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