Opioid Toxidrome
Small pupils suggest opioid intoxication, but normal pupil size doesn't exclude it - Josh Farkas
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.
Resources
Narcotic or opioid toxidrome
Start naloxone with small doses, i.e. 0.04 mg, and not the standard dose of 0.4 mg IV/IM.
Mystifying Toxidrome: A Case of Heroin Body Packer Syndrome
Drug trafficking is an international problem. Over years it has increased in prevalence and concealment methods. Body packers swallow wrapped packets of illicit drugs, mainly cocaine and heroin and try to conceal them from security personnel. They present to physicians either as body packer syndrome with symptoms of intoxication or asymptomatically on suspicion of drug concealment, for observation.
Opioids & Sedatives Toxicity
Dose: standard is (.4mg) , but we start with( .1mg) and see the response if it didn’t work we increase gradually till we reach .4mg.
The Challenge Posed by New Synthetic Opioids: Pharmacology and Toxicology
Recently, NSOs have been involved in a significant spike of acute intoxications (classic opioid toxidrome) and overdose deaths in North America, challenging healthcare professionals, law enforcement agencies fighting against their diffusion, and policymakers trying to restrain their use
The ToxIC NOSE (Novel Opioid and Stimulant Exposure)
Although maternal MAT therapy is low risk to breast feeding children, opioid toxicity in young children occurs easily via other methods. Notably, exploratory ingestions of improperly secured medications and intentional administration of opioids by caregivers does occur.
Tramadol revisited
If the patient has an opioid toxidrome, treatment with naloxone is indicated. For agitation, tremulousness, and/or seizures, benzodiazepines are the first line therapy. Although there are conflicting reports on naloxone to treat seizures or naloxone causing seizures after tramadol ingestion, it is important to remember that mechanistically, naloxone does not have any antiepileptic properties.
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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