Opioid Toxidrome

Small pupils suggest opioid intoxication, but normal pupil size doesn't exclude it - Josh Farkas

Opioid Toxidrome
Opioid Toxidrome

image by: International Overdose Awareness Day

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CRACKCast E162 – Opioids

Classic triad: respiratory depression + CNS depression + miosis

Neuro: CNS depression, spongiform leukoencephalopathy/ parkinsonism (from “chasing the dragon”, smoking heroin fumes from heating up in tin foil). Seizures (meperidine). Hypoxia and CNS depression can lead to anoxic brain injury. Serotonin syndrome (Meperidine, methadone, tramadol, fentanyl).

Respiratory: opioids shut down medullary resp centre (suppresses your brain’s ability to notice hypercapnia)→ hypopnea, apnea... Respiratory depression is the essential feature of opioid intoxication.

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Resources

 CRACKCast E162 – Opioids

The opioid toxidrome includes three prominent findings - CNS depression, miosis, and most importantly, respiratory depression - but presentations may be variable.

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