Opiod poisoning

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

• Pharmacological

Antidote-Naloxone

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

Prevention

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

Do’s

• 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

Don’ts

• 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

References

1. STG