Opiate Overdose

Effects

• CNS - sedation and respiratory depression, seizures w/ meperidine, propoxyphene and dextromethorphan (Esp. in renal insult)
• Pulmonary - acute noncardiogenic pulmonary edema

Diagnosis

• H&P (pinpoint pupils, CNS and resp. depression)
• Response to naloxone
• Labs: urine tox (will not show fentanyl), CBC, eletrolytes, glucose, ABG, CXR, consider acetaminophen/ASA levels if combination drugs ingested

Treatment

• ABCs, oxygen
• Naloxone 0.2-2mg IV, may repeat dose q2-3 min up to total of 10-20mg IV. Necessary to monitor at least 3-4 hours after last naloxone dose which has half-life of 1 hour. Opiates have longer half life. Recommend 6-12 hour observation after opioid-induced coma and monitor for acute withdrawal syndrome in opiate dependent patients.
• If patient is intubated for airway protection/hypercarbia, naloxone is not necessary
• Decontaminate via gastric lavage, charcoal, cathartic.

Source: Uptodate: Opiate overdose