Opioid Toxicity

Question 1

What causes opioid toxicity?

Answer 1

This class of drugs has a high potential for abuse as they stimulate the reward center of the brain in addition to their intended medical use.

Question 2

What are the subjective/physical exam findings associated with opioid toxicity?

Answer 2

• Subjective: Hypothermia, drowsiness, mental status changes
• Physical findings: Shallow respirations, respiratory depression, Miosis, coma

Question 3

What lab/diagnostic tests are monitored with opioid toxicity?

Answer 3

• Evaluate the toxicology screen and urine screen.
• Monitor blood glucose and serum creatinine phosphokinase.

Question 4

How do you manage patients with opioid toxicity?

Answer 4

1. Continuous EKG monitoring
2. Adequate ventilation, respiratory support, mechanical ventilation
3. Naloxone (Narcan, Evzio Autoinjector) 0.4-2mg IV/IM or intranasal. May need to repeat every 20-60 minutes. Can consider a continuous infusion (0.4-0.8 mg/hr) if boluses are not effective.
4. Activated charcoal 1 gram/kg single dose PO/NG