Opioid Poisoning
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T40.2 DESCRIPTION Codeine is a common drug of abuse. The duration of action of morphine is 3–6 hours. Other oral agents, e.g. codeine and long acting morphine, demonstrate a delayed effect of up to 4–12 hours. DIAGNOSTIC CRITERIA Altered level of consciousness. Classic triad of CN
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: T40.2
DESCRIPTION
Codeine is a common drug of abuse.
The duration of action of morphine is 3–6 hours. Other oral agents, e.g. codeine and long acting morphine, demonstrate a delayed effect of up to 4–12 hours.
DIAGNOSTIC CRITERIA
- Altered level of consciousness.
- Classic triad of CNS depression, respiratory depression and pinpoint pupils.
- Hypotension, hypothermia, bradycardia and hyporeflexia.
- Vomiting is common with the risk of aspiration, especially in patients with depressed level of consciousness.
Note:
Symptoms may take time to develop. May be awake and alert in the early phase 1–2 hours after ingestion. Neonates of mothers using heroin may present with withdrawal, manifested as jitteriness.
GENERAL AND SUPPORTIVE MEASURES
- Airway protection is a priority.
- Supportive care, ventilate with bag-mask device.
- Monitor oxygen saturation constantly.
- Observe for urinary retention.
MEDICINE TREATMENT
- Activated charcoal.
If respiratory depression or depressed level of consciousness:
- Provide airway support
- Ventilate until PaCO2 normal
- Naloxone, IV, 0.1 mg/kg.
- If no response after 5 minutes, repeat dose and titrate according to response.
- Duration of action of naloxone is 20–30 minutes.
- If repeated doses of naloxone are necessary, a continuous IV infusion of naloxone can be instituted (0.01 mg/kg/hour).
CAUTION
All patients treated with naloxone should be observed for at least 12 hours for relapse, especially if a long acting opioid has been ingested.
REFERRAL
- Patients requiring multiple doses of naloxone.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 18: Poisoning, 18.1 Poisoning, 18.1.10 Opioid Poisoning