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Opioid poisoning (Pathophysiology (Strong: morphine, diamorphine (heroin),…
Opioid poisoning
Pathophysiology
Strong:
morphine, diamorphine (heroin),
buprenoprhine, methadone, pethidine
Weak:
tramadol, codeine, dihydrocodeine
Agonism of Mu receptors and exagerrated
effects i.e. resp depression and reduced conciousness
Clinical
presentation
Respiratory depression
Seizures
Reduced conciousness/coma
Diagnosis
Examination
General: track marks, injuries, compartment synd
Cardio: cyanosis, hypotension, low RR
Resp: cyanosis, low RR, apnoea
Neuro: pinpoint pupils, seizure, coma
Investigations
Bedside: obs, ECG (arrhythmia), BM
Bloods: FBC, U+E, LFTs, ABG, CK
History
PC/HPC: symptoms, amount, timing
PMH: known opioid addiction, chronic pain
DH: methadone, codeine etc.
SH: drug abuse, alcohol, smoking
Management
Initial ABCDE
Definitive
Medical
Opioid antagonist
Indication: opioid OD
E.g. naloxone
MOA: antagonises effect
NB: short t1/2, needs monitoring for >6h
after last dose (cardiac monitor, obs)
SEs: withdrawal syndrome in addicts
Activated charcoal
Indication: sustained release
MOA: reduces absorption
Conservative
Regular obs (incl neuro)
TOXBASE
Definition
Ingestion of an amount of
opioid sufficient to cause toxicity