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:

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.

READ ALSO:

• TOXICITY CHAPTERS;
• Propofol Infusion Syndrome (PRIS)
• Antidote Chart

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