Version May 2024
| To obtain emergency consultation with a medical toxicologist, in the United States, call 1-800-222-1222 for the nearest regional poison control center. Contact information for poison control centers around the world is available at the WHO website and in the UpToDate topic on regional poison control centers (society guideline links). |
| Clinical features* |
| Depressed mental status ranging from lethargy to coma |
| Miotic pupils (often pinpoint)¶ |
| Depressed respirations including apnea |
| Bradycardia and hypotension |
| Decreased to absent bowel sounds |
| Track marks (adolescents with IV drug abuse) |
| Ancillary studiesΔ |
| Blood glucose and pulse oximetry in patients with coma and depressed respirations |
| Serum ethanol level, especially in adolescents with recreational or suicidal overdose |
| Serum acetaminophen if suicidal intent or ingestion of combination medications (eg, acetaminophen with oxycodone) |
| Electrocardiogram in patients intoxicated with methadone (prolonged QTc) or propoxyphene (prolonged QRS) |
| Chest radiograph in patients with persistent respiratory findings that suggest pulmonary aspiration or noncardiogenic pulmonary edema |
| Urinalysis, serum electrolytes, blood urea nitrogen, creatinine, and creatine kinase in patients with prolonged immobilization or muscular rigidity at risk for rhabdomyolysis |
| Rapid urine pregnancy test in postmenarchal girls |
| Rapid urine testing for opioids in young children and infants with coma from unknown cause or in whom intentional poisoning by a caretaker is suspected |
| Treatment |
| Support airway and breathing using bag-mask ventilation with 100% inspired oxygen until naloxone is administered. |
Give naloxone for deep coma and respiratory depression as follows◊:
|
| Give activated charcoal (1 gram/kg orally or by nasogastric tube, maximum dose 50 grams) to alert young children and adolescents who present within one hour of oral overdose¥. |
| In cases of suspected child abuse, consult an experienced children protection team (if available) and report suspicion to the appropriate governmental agency. |
| Consult psychiatry for patients with substance abuse or suicidal intent. |
AC: activated charcoal; ET: endotracheal tube; IM: intramuscular; IO: intraosseous.
* The diagnosis of opioid intoxication is based upon clinical features and response to antidotal therapy.
¶ Small pupils are not always present in children and adolescents with opioid intoxication.
Δ Other ancillary studies may be indicated in selected patients in whom trauma, infection, or other etiologies besides poisoning are suspected. Refer to UpToDate topics on stupor and coma in children and pediatric occult toxic exposures.
◊ Naloxone may also be given intramuscularly or intratracheally via endotracheal tube (ET) in children or adolescents with poor IV access. If an endotracheal tube is present, ET administration is preferred over intramuscular, if IV and IO routes not available. ET dose is approximately two to three times IV dose.
§ Naloxone administration is not recommended as part of initial resuscitation of neonates in the delivery room. Refer to UpToDate topics on neonatal resuscitation.
¥ AC should be withheld in patients who are sedated and may not be able to protect their airway, unless endotracheal intubation is performed first or naloxone therapy is effective in maintaining an alert state. Endotracheal intubation should not be performed solely for the purpose of giving AC.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
