First Things First (assess & treat for the following)
- Manage the ABCs.
- Primary manifestations of opiate toxicity: respiratory depression & depressed mental status
- Aggressive airway mgt is indicated in a pt who cannot maintain airway protection.
- Attempt naloxone to reverse toxicity – may give IV, IM, sub Q, via ETT (at 2.5-3 times IV dose diluted in 10 ml NS), but not PO.
- Attempt to use lowest effective dose to avoid precipitating opioid withdrawal.
- Start w/ 0.1 mg naloxone IV, then increase stepwise if ineffective (ie, 0.1 mg, then 0.4 mg, then 2 mg, and finally 10 mg).
- Depressed mentation/respiration persisting after 10 mg of IV naloxone is likely not related to opioid toxicity.
- Caution: Naloxone’s clinical duration of action is 20-90 min & many opiates have a longer duration of action (especially in the overdose setting). Thus, respiratory depression may recur & pt will need to be redosed or started on a naloxone infusion (see “Specific Treatment” section).
- Naloxone is typically very safe. Paramedics are allowed to administer naloxone (as well as glucose) without an MD order in many states.
- GI decontamination
- If route of ingestion was oral & time of ingestion was within the past 60 min, then gastric lavage may be beneficial.
- Activated charcoal (1 g/kg PO or per NG/lavage tube) is effective in adsorbing opioids within gut lumen in oral overdoses.
- Ensure that airway will be continuously protected before initiating gastric lavage or administering activated charcoal.
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Last updated: May 7, 2010
"Opiate Intoxication." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534154/all/Opiate_Intoxication.
Opiate Intoxication. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534154/all/Opiate_Intoxication. Accessed June 6, 2023.
Opiate Intoxication. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534154/all/Opiate_Intoxication
Opiate Intoxication [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2023 June 06]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534154/all/Opiate_Intoxication.
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TY - ELEC T1 - Opiate Intoxication ID - 534154 Y1 - 2010/05/07/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534154/all/Opiate_Intoxication PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -