Opiate overdose

Background

• Dx based on pin-point pupils, respiratory depression, drowsiness or coma
• Pupils may be dilated if the patient is hypothermic, hypotensive (e.g. secondary to opioids), hypoxic
• Convulsions and pulmonary oedema may develop
• Therapeutic trail of Naloxone (short-acting and repeated doses/infusion required)
• Naloxone can be delivered Intra-nasally, as a Nebuliser or IM
• Nebulised is an option when the patient is relatively stable (as long as the patient had some spontaneous respiratory effort and no severe cardiorespiratory compromise. (Ref))
• Naloxone should only be given IV in cases requiring multiple doses of Naloxone (e.g. methadone OD).

Naloxone

Intra-nasally

• 2 mg (2 ml) of Naloxone and attach nasal atomizer (details)

Nebulised

• Nebulised - 2 mg of Naloxone with 3 mL of normal saline

Intramuscular

• 0.4mg aliquots up to 2mg

IV infusion

• Start an IV Naloxone infusion at 2/3 the first hours requirements per hour
• Add 4 mg of naloxone (10ml of 400mcg/ml) to 30 mL of NaCl making a 100mcg/mL solution for infusion using an IV pump
• Titrate to response