Acute Opioid Intoxication in Adults

1. Acute Opioid Intoxication in Adults
Ade Wijaya, January 2019

2. Introduction
• Extracted from the poppy plant
• Modulate the release of neurotransmitters
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3. Clinical Effects
• The analgesic effects of opioids result from inhibition of nociceptive
information at multiple points of its transmission from the
peripheral nerve to the spinal cord to the brain.
• Euphoria results from increased dopamine released in the
mesolimbic system
• Anxiolysis results from effects on noradrenergic neurons in the locus
ceruleus
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4. Pharmacokinetics
• Elimination: renal
• Metabolism: hepatic
• The most clinically important pharmacokinetic difference is a wide
variation in serum half-life
Davies G, Kingswood C, Street M. Pharmacokinetics of opioids in renal dysfunction. Clin Pharmacokinet 1996; 31:410.

5. Pathophysiology
• Opioids increase activity at one or more G-protein–coupled
transmembrane molecules, known as the mu, delta, and kappa opioid
receptors
• The receptors are widely distributed throughout the human body
• The mu opioid receptor is responsible for the preponderance of
clinical effects caused by opioids
• Mu opioid receptors desensitization  tolerance
• 60-200 mg morphine usually can induce fatal overdose
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6. Clinical Features
• Altered mental status ranging from mild euphoria or lethargy to coma
• Miotic pupils
• Decreased bowel sounds
• Low to normal heart rate and blood pressure
• Hypoventilation
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7. Physical Examination
Stolbach A, Hoffman RS. Acute opioid intoxication in adults. UpToDate, Waltham, MA.(Accessed on September 24, 2014.). 2015.

8. Treatment
• Ensure adequate ventilation
• Supplemental oxygen
• Naloxone (0.4 mg IV), followed by a rapid escalation to higher doses
(2 mg) if no response is observed within 2–3 min
Stolbach A, Hoffman RS. Acute opioid intoxication in adults. UpToDate, Waltham, MA.(Accessed on September 24, 2014.). 2015.
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11. Summary
• Opioid analgesic overdose is a life-threatening condition
• Naloxone may have limited effectiveness in patients with poisoning
from long-acting agents.
• The unpredictable clinical course of intoxication demands empirical
management of this potentially lethal condition.