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Opiod poisoning



Opiate intoxication can occur any time from birth (Delivery/ maternal opiod usage) to terminal care. Drugs that may be involved include: Codeine, Diamorphene, Di Hydrocodeine, Fentanyl, Heroin, Loperamide, Methadone, Morphine, opium, Tramadol (etc.) alone or in combination.

Risk Factors

• Drug users
• Social disadvantaged
• People who had used the drug earlier for treatment
• Those using alcohol and other sedatives

Signs and symptoms

Diagnostic criteria

Acute toxicity:

• Drowsiness
• Nausea and vomiting

Chronic toxicity:

• Constipation
• Loss of appetite
• Nausea and vomiting
• Respiratory depression
• Tachycardia
• Hypotension
• Pin point pupils



  • Non-pharmacological

    • Check the airway
    • Intubate the patient who cannot protect their airway
    • Give oxygen
  • Pharmacological


    Hypoventilating patient with spontaneous ventilation

    Naloxone dosage

    Adults & children> 20kg:

    • Initial dose 0.5mg titrated upward until Respiratory Rate is ≥12

    Children (<20kg):

    • 0.01mg/kg IV (Maximum 2mg/dose), increase till hypoventilation resolves

    Patients with apnoea:

    Newborn with apnoea secondary to maternal opiod:

    • 0.01mg/kg IV/IM (Maximum 0.4mg/kg/dose)

    Children: <20kg

    • 0.1mg/kg (Maximum 2mg/dose) start then repeat doses with continuous infusion as required.

    Adults and children>20kg

    • Higher dose of naloxone (0.2-1mg and titrate to clinical response

    For life threatening Opioid toxicity

    Pediatrics (< 20kg) dosing:
    • 0.1mg/kg/IV (Maximum 2mg/dose). Repeat dose/continuous infusion as required

    Adults and children (More than 20kg):

    • 2mg IV.

    o The dose should be repeated every 3 min until improvement of Respiratory Distress Syndrome
    o If maximal cumulative dose of 10mg is reached and the respiratory insufficiency has not improvement, consider other pathology

    NOTE: Withdrawal reaction might be life threatening in neonatal period, hence low doses should be given


Educate the patient on Dos and Don’ts of poisoning prevention.


• Keep medicines and poison in proper containers and out of reach of children
• Use containers with child resistant caps
• Keep all products in their original container
• Read medicine labels carefully to avoid mistake


• Leave container open
• Transfer products from their origin
• Remove labels from the medicine products
• Put tablets into another containers such as purse or envelope
• Medicine/tablets as sweet
• Take your medicine in front of children as they often copy

Updated on,

14 Novemba 2020 15:01:01


    1. STG
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