naloxone and Coma

Hemodialysis therapy has been used in the treatment of acute alcohol intoxication for many years, especially acute severe alcohol intoxication.. This study aimed to evaluate whether the combination of conventional treatment and naloxone with hemodialysis has advantages over conventional treatment and naloxone alone in patients with acute severe alcohol intoxication.. After searching 12 databases and 2 clinical trial centers. According to the established inclusion and exclusion criteria, the qualified literatures were screened. The outcome indicators were length of hospital stay, coma time, time of symptom disappearance, the overall complication rate, the incidence of pancreatitis, the incidence of aspiration pneumonia, the incidence of hepatic and renal dysfunction. Analysis was performed using Revman 5.3.. This meta-analysis included 13 studies, including 932 subjects. In the treatment of acute severe alcohol intoxication, the use of hemodialysis on the basis of conventional treatment and naloxone could reduce the length of hospital stay (WMD = -15.16, 95% CI: -17.45 to -12.86, p < 0.001) in hours and (WMD = -4.89, 95% CI: -5.53 to -4.25, p < 0.001) in days; coma time (WMD = -5.43, 95% CI: -6.43 to -4.43, p < 0.001); time of symptom disappearance (WMD = -3.92, 95% CI: -5.37 to -2.47, p < 0.001); the overall complication rate (RR = 0.39, 95% CI: 0.28-0.55, p < 0.001); the incidence of pancreatitis (RR = 0.14, 95% CI: 0.05-0.43, p = 0.0006); the incidence of aspiration pneumonia (RR = 0.15, 95% CI: 0.04-0.66, p = 0.01), and the incidence of hepatic and renal dysfunction (RR = 0.21, 95% CI: 0.06-0.72, p = 0.01).. It can be concluded that compared with the use of conventional treatment and naloxone alone, the use of hemodialysis on the basis of conventional treatment and naloxone for acute severe alcohol intoxication can reduce the length of hospital stay, coma time, time of symptom disappearance, and the incidence of some complications rate. Large scale, multicenter, and well-designed RCTs are needed in the future to prove our conclusions.

Topics: Alcoholic Intoxication; Coma; Humans; Kidney Diseases; Multicenter Studies as Topic; Naloxone; Pancreatitis; Pneumonia, Aspiration; Renal Dialysis

Flumazenil and naloxone are considered to be pharmacologically ideal antidotes. By competitive binding at the molecular target receptors, they are highly specific antagonists of two important drug classes, the benzodiazepines and opioids, respectively. Both antidotes enjoy rapid onset and short duration after parenteral administration, are easily titrated and are essentially devoid of agonist effects. Yet only naloxone is widely used as a component of the 'coma cocktail', a sequence of empirical treatments to correct altered mental status, while experts discourage the use of flumazenil for such patients. This review contrasts the history, indications, published evidence and novel applications for each antidote in order to explain this disparity in the clinical use of these 'ideal' antidotes.

Topics: Analgesics, Opioid; Antidotes; Benzodiazepines; Coma; Drug Overdose; Flumazenil; Humans; Naloxone

Topics: Adult; Antidotes; Child; Coma; Dose-Response Relationship, Drug; Drug Administration Routes; Drug Overdose; Drug Therapy, Combination; Flumazenil; Glucose; Humans; Naloxone; Narcotic Antagonists; Oxygen; Poisoning; Suicide, Attempted; Thiamine

Clinicians in the emergency department are often confronted with coma patients due to poisoning. A systematic general approach involving early consultation with a neurologist is of paramount importance. A high index of suspicion, a systematic first assessment already in the prehospital phase and early stabilisation of vital functions are the essential first steps. Specific antidotes like hypertonic glucose and thiamine are part of a "coma cocktail". The opiate antagonist naloxone should be used only when clinically indicated and in a titrated way. Flumazenil should only be used with caution and in restricted cases. Clinical neurological evaluation and technical investigations like CT-scan and laboratory tests should make part of a careful diagnostic plan. Toxicological tests deserve their place in the diagnostic work up of a coma patient with suspected poisoning. Knowledge of the possibilities of the toxicology lab and optimal communication with the clinical toxicologist is important for optimal patient care.

Topics: Accidental Falls; Alcohol-Induced Disorders, Nervous System; Alcoholic Intoxication; Antidotes; Brain Injuries; Coma; Diabetic Coma; Diagnosis, Differential; Diagnostic Tests, Routine; Drug Overdose; Emergencies; Ethanol; First Aid; Flumazenil; Glucagon; Glucose; Humans; Hypoglycemia; Hypoxia, Brain; Monitoring, Physiologic; Naloxone; Neurologic Examination; Stroke; Thiamine

Opioids and benzodiazepines are two of the most common exposures that cause depressed mental status in children. Establishing a diagnosis of these intoxications may be difficult and is complicated by drugs from these two classes that are not detectable by routine toxicologic screening techniques. Naloxone and flumazenil can be used as diagnostic as well as therapeutic medications in these ingestions. We present a brief review of the mechanism of action, administration recommendations, and adverse effects of naloxone and flumazenil. Although the empiric use of naloxone and flumazenil in the comatose adult patient who presents to the emergency department is being reexamined, many of the concerns do not apply to children. There is still an important role for empiric administration of both naloxone and flumazenil.

Topics: Adolescent; Antidotes; Benzodiazepines; Child; Child, Preschool; Coma; Drug Overdose; Flumazenil; Humans; Infant; Infant, Newborn; Naloxone; Narcotics

Flumazenil is an important adjunct to the diagnosis and treatment of benzodiazepine toxicity. It must be used cautiously with attention to a number of clinical caveats. Currently it is advised that flumazenil should not be used routinely in all patients with altered mental status, but when used selectively, it is a very safe and extremely useful antidote.

Topics: Animals; Coma; Emergencies; Flumazenil; Glucose; Humans; Naloxone; Thiamine

In summary, naloxone has proved to be effective and safe during its years of use for narcotic antagonism. Its usefulness in non-narcotic coma and shock remains controversial, although some encouraging but inconclusive evidence exists. The final answer lies on the horizon of medicine; it awaits further delineation of the role of endogenous opioids in health and disease and clear statistical verification of naloxone's efficacy in such disease states.

Topics: Animals; Arousal; Coma; Humans; Naloxone; Shock; Shock, Cardiogenic; Shock, Hemorrhagic; Shock, Septic

Topics: Adolescent; Adult; Amenorrhea; Arthritis, Infectious; Bone Diseases; Chemical and Drug Induced Liver Injury; Coma; Endocarditis, Bacterial; Extremities; Female; Fetal Growth Retardation; Hepatitis, Viral, Human; Heroin Dependence; Humans; Infant, Newborn; Ischemia; Male; Naloxone; Neurologic Manifestations; Pregnancy; Pregnancy Complications; Respiratory Tract Diseases; Sepsis; Skin Manifestations; Tetanus

It has previously been reported that prior administration of naloxone may prevent the decrement in performance produced by alcohol. To be clinical value, however, naloxone must be shown to reverse rather than prevent this decrement. This study examined the effect of naloxone given after consumption of alcohol. A double blind balanced crossover protocol was used to examine the effect of either 1.2 mg or 10 mg naloxone on the sensory-motor impairment produced by blood alcohol concentrations maintained between 75 and 85 mg/100 ml. This alcohol concentration significantly impaired two measures of sensory-motor performance, but there was no evidence that either dose of naloxone could reverse this decrement. We tested our subjects for a chlorpropamide alcohol flush but none gave a positive response. These results indicate that naloxone (1.2 mg or 10 mg) does not reverse the sensory-motor impairment produced by alcohol intoxication in subjects who do not exhibit a chlorpropamide alcohol flush. Nearly all the subjects exhibited somnolence after receiving alcohol and naloxone (1.2 mg or 10 mg) but not after receiving alcohol and saline.

Topics: Adult; Coma; Double-Blind Method; Ethanol; Humans; Male; Middle Aged; Motor Skills; Naloxone

Several overdoses of the antiepileptic drug perampanel have been reported in adults, but very few have been reported in children. We report the case of an observed exploratory ingestion of perampanel in a 2-year-old child that resulted in ataxia and prolonged coma.. A previously healthy 2-year-old female patient presented to the emergency department (ED) 30 minutes after the witnessed ingestion of 30 mg of perampanel (2 mg/kg). Within minutes of ingestion, she displayed ataxia and inability to walk. Upon ED presentation, she had normal vital signs but was minimally responsive with physical stimulation. Naloxone was given without response. She was intubated because of profound central nervous system depression and transferred to a pediatric tertiary care facility. She remained intubated with no pharmacological sedation. Physical exam showed a horizontal nystagmus. Detailed neurologic examination of ataxia and coordination was not possible, and she did not demonstrate hyperreflexia, clonus, or rigidity. Her mental status gradually improved, and she was extubated approximately 72 hours after exposure. After extubation, the patient still exhibited truncal ataxia and did not return to baseline until 96 hours post ingestion. Serum drawn approximately 16 hours after exposure showed 870 ng/mL perampanel (ref < 20 ng/mL). She remained hemodynamically stable throughout her hospital course, despite protracted depressed mental status.. Given the severity of our patient's presentation, pediatric patients showing symptoms of perampanel overdose should be triaged to the ED for evaluation in anticipation of a prolonged clinical course with decreased consciousness and hypoventilation.

Topics: Anticonvulsants; Ataxia; Child, Preschool; Coma; Drug Overdose; Female; Humans; Naloxone; Nitriles; Pyridones; Treatment Outcome

Methadone is well known for its long duration of action and propensity for mortality after an overdose. The present research was aimed at evaluating the clinical manifestations and time trends of methadone exposure in patients in US hospitals.. We queried the American College of Medical Toxicology's Toxicology Investigators Consortium case registry for all cases of methadone exposure between January 1, 2010, and December 31, 2017. The collected information included demographic features, clinical presentations, therapeutic interventions, poisoning type (acute, chronic, or acute on chronic), and the reason(s) for exposure. Descriptive data and relative frequencies were used to investigate the participants' characteristics. Our data analysis was performed using SPSS version 19 and Prism software. The trends and clinical manifestations of methadone poisoning over the time period of the study were specifically investigated.. Nine hundred and seventy-three patients who met our inclusion criteria, with a mean age of 41.9 ± 16.6 years (range: 11 months-78 years) were analyzed. Five hundred eighty-two (60.2%) were male. The highest rate of methadone poisoning was observed in 2013. There was an increasing rate of methadone exposures in 2010-2013, followed by a decline in 2014-2017. The most common clinical manifestations in methadone-poisoned patients were coma (48.6%) and respiratory depression (33.6%). The in-hospital mortality rate of methadone poisoning was 1.4%.. ToxIC Registry data showed that inpatient methadone exposures enhanced from 2010 to 2013, after which a reduction occurred in the years 2014 to 2017.

Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Child; Child, Preschool; Coma; Drug Overdose; Female; Hospital Mortality; Hospitalization; Humans; Infant; Male; Methadone; Middle Aged; Naloxone; Registries; Respiratory Insufficiency; United States; Young Adult

We present an unusual cause of respiratory arrest resulting from sole ingestion of home-brewed opium tea. A 64-year-old woman was found unresponsive and in respiratory arrest by a first responder. There were no obvious signs of regular recreational drug use. On presentation to the local district general hospital, the patient was in extremis, with severe physiological and biochemical derangements. A naloxone infusion was commenced and she later made a good recovery. It was subsequently discovered that she had brewed opium tea from opium buds she had picked from a nearby commercial poppy farm, a practice she had learnt while in Afghanistan.

Topics: Administration, Intravenous; Afghanistan; Coma; Female; Humans; Middle Aged; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Opium; Tea; Treatment Outcome

Topics: Administration, Inhalation; Adult; Analgesics, Opioid; Coma; Drug Packaging; Fentanyl; Humans; Male; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Pneumonia; Respiration, Artificial

Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the findings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.

Topics: Administration, Oral; Adult; Coma; Drug Compounding; Drug Overdose; Female; Humans; Male; Methadone; Naloxone; Narcotic Antagonists; Respiratory Distress Syndrome

Although there are limited data on oxycodone overdose, it has been suggested that, in addition to central nervous system (CNS) depression, oxycodone may cause QT prolongation. Given the high prescription rate and increasing use of oxycodone, an understanding of its effects and treatment in overdose is necessary.. To investigate the clinical features, electrocardiogram (ECG) parameters and treatment of oxycodone overdose.. Retrospective review of a clinical database.. One hundred and thirty-seven oxycodone overdoses were identified from admissions to a toxicology unit between January 2001 and May 2011. Demographic information, details of ingestion, clinical effects, ECG parameters [heart rate (HR), QT and QRS], naloxone use and length of stay (LOS) were extracted from a clinical database. QT was measured manually and plotted on a QT nomogram. LOS was extracted for all overdoses over the same period.. From 137 oxycodone overdoses, 79 (58%) ingested immediate release (IR) and 58 (42%) ingested sustained release (SR) or a combination of IR and SR. The median age was 40 years [interquartile range (IQR): 33-49 years], and 87 were female (64%). The median ingested dose of IR oxycodone was 70 mg (IQR: 40-100, range: 5-200), compared to 240 mg (IQR: 80-530, range: 30-1600) for SR oxycodone. Benzodiazepines were the most frequent co-ingested drug in 52 (38%) cases. No arrhythmias were recorded. Twenty-four patients (18%) had bradycardia of which five had a HR < 50 beats/min. From 116 available ECGs, the median QRS was 95 ms (IQR: 90-102 ms), and there were 20 (17%) abnormal QT-HR pairs. Naloxone boluses were required in 65 admissions (47%), and 34 (25%) required a naloxone infusion. There was higher overall naloxone use with SR and IR + SR (32/58, 55%) compared to IR oxycodone (33/79, 42%). The median LOS was 18 h (IQR: 12-35), which was greater than the median LOS for all toxicology admissions at 15 h (IQR: 8-24) over the same period. Patients requiring a naloxone infusion had an even greater LOS of 36 h (IQR: 20-62 h).. In addition to the expected CNS depression, the opioid oxycodone can cause bradycardia and QT prolongation in overdose. The SR formulation is associated with the use of naloxone infusions and a longer LOS.

Topics: Adult; Analgesics, Opioid; Bradycardia; Coma; Drug Overdose; Electrocardiography; Female; Humans; Length of Stay; Long QT Syndrome; Male; Middle Aged; Naloxone; Narcotic Antagonists; Oxycodone; Retrospective Studies

We describe the first ziprasidone overdose with quantitative serum levels of a pediatric patient in coma and with pinpoint pupils. This case is an important contribution to the pediatric ziprasidone literature because it illustrates that ingestion of just 1 pill may result to profound mental status and respiratory depression in a child. H.C., a 30-month-old girl, presented to the emergency department approximately 30 minutes after an accidental ingestion of an adult family member's medication. The child was found on the floor surrounded by numerous pills and was witnessed to have ingested at least 1 tablet by a caregiver. After finding the child with the pills, the family observed the child for a brief period but transported her to the hospital after she became lethargic and unresponsive. The child received 2 doses of 0.4 mg of intravenous naloxone without change in her neurologic status. The child then underwent a rapid sequence intubation for airway protection and subsequently received gastrointestinal decontamination with 15 g of activated charcoal via the orogastric tube. Ziprasidone is an atypical antipsychotic drug that was approved by the Food and Drug Administration in February 2001 for the general treatment of schizophrenia in adults. Previously reported pediatric ziprasidone overdoses describe a syndrome of sedation, tachycardia, hypotonia, and coma consistent with that of the patient described in this paper. In pediatric ziprasidone overdose, QTc prolongation and hypotension have also been illustrated, but seizures have not been reported. An interesting aspect of this case is the development of pinpoint pupils unresponsive to naloxone. This phenomenon has been reported before with overdose of olanzapine, a similar atypical antipsychotic. The mechanism of miosis associated with overdose of atypical antipsychotics is unclear but is likely related to interference with central innervation of the pupil. Pupil size is maintained by a balance between sympathetic and parasympathetic neurohumeral tones. We propose that an overdose of an alpha-1 receptor blocking agent, such as ziprasidone, results in unopposed parasympathetic stimulation resulting in miosis.

Topics: Adrenergic alpha-1 Receptor Antagonists; Antidotes; Antipsychotic Agents; Charcoal; Child, Preschool; Coma; Drug Resistance; Emergencies; Female; Humans; Hypotension, Orthostatic; Intubation, Intratracheal; Miosis; Naloxone; Piperazines; Tachycardia; Thiazoles

Topics: Adult; Anesthetics, Intravenous; Antidotes; Cholinesterase Inhibitors; Coma; Flumazenil; Humans; Male; Metabolic Clearance Rate; Midazolam; Naloxone; Narcotic Antagonists; Physostigmine; Time

The changing pattern of acute poisoning may affect complications and outcome in these patients. An update study on acute poisonings was therefore performed and compared to similar data from 1980.. A prospective cross-sectional multi-center study of all adult patients (> or = 16 years) hospitalized in Oslo with a main diagnosis of acute poisoning, irrespective of intention, over a one-year period.. Of 947 admissions, 222 (23%) were comatose. Complications were observed in 173 (18%), slightly reduced from 1980 (22%). Ten (1.1%) died and six (0.6%) got permanent sequelae, of which seven and five were drug- or alcohol-related, respectively. Seventy-five percent received treatment besides observation; 39% received antidotes, increased from 21% in 1980, most frequently flumazenil (23%) and naloxone (14%).. In-hospital mortality in poisoned patients remained low, few patients entailed complications, and most patients survived without permanent sequelae. Drug- and alcohol-abuse related poisonings were most severe.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antidotes; Coma; Cross-Sectional Studies; Ethanol; Female; Flumazenil; Hospital Mortality; Hospitalization; Humans; Illicit Drugs; Male; Middle Aged; Naloxone; Norway; Poisoning; Prospective Studies; Severity of Illness Index; Treatment Outcome

Topics: Accidents; Administration, Cutaneous; Analgesics, Opioid; Antihypertensive Agents; Clonidine; Coma; Drug Overdose; Emergency Treatment; Fentanyl; Humans; Infant; Naloxone; Narcotic Antagonists; Patient Education as Topic; Seizures; Self Administration

We report on the preclinical management of a 4-year-old child who was found in a comatose condition with respiratory failure after accidental ingestion of methadone. Emergency airway management was carried out with endotracheal intubation instead of administering the antagonist naloxone. The child could be extubated 12 h later and was released from hospital after 3 days with no neurological symptoms. The authors attempt to formulate an algorithm for the preclinical management of opioid intoxication with reference to the literature and own experience. Endotracheal intubation seems to be superior to the use of the antagonist naloxone, especially in a critical situation. This is the only way to ensure a rapid oxygenation with adequate airway protection and with the simultaneous avoidance of the side-effects of naloxone. A restrictive and critical administration of the opioid antagonist naloxone is recommended when there is suspicion of opioid ingestion but no signs of intoxication.

Topics: Analgesics, Opioid; Child, Preschool; Coma; Emergency Medical Services; Female; Humans; Intubation, Intratracheal; Methadone; Naloxone; Narcotic Antagonists; Oxygen Inhalation Therapy; Respiratory Insufficiency

Topics: Coma; Emergency Medical Services; Glucose; Humans; Naloxone; Narcotic Antagonists; Quality Assurance, Health Care; United States

Topics: Anti-Arrhythmia Agents; Atropine; Baclofen; Child; Coma; GABA Agonists; Humans; Infusion Pumps, Implantable; Morphine; Naloxone; Narcotic Antagonists; Oxygen; Postoperative Complications

It should be clear from this discussion that coma cocktails are a bad idea and should be immediately abandoned. In fact, the indiscriminate use of the coma cocktail may indeed harm patients, EMS has evolved to a point where any EMS provider should be able to reasonably determine the most likely cause of coma, or, in a worst-case scenario, narrow the cause to but a few possibilities. Certainly, patients with bona fide hypoglycemia should receive IV glucose. Because the consequences of prolonged hypoglycemia are severe, if there's a doubt about whether hypoglycemia is present, then glucose should be empirically administered. Naloxone should be used only for those cases in which a narcotic overdose appears likely. Similarly thiamine administration should be limited to patients suspected of chronic alcohol abuse and who exhibit at least one of the three symptoms of WE described above. Flumazenil has no role in the routine treatment of coma unless the patient is known to not be benzodiazepine dependent and the overdose is known to result only from benzos--two very difficult requirements to verify in the back of an ambulance at 2 a.m. Coma cocktails are bad medicine. Let's banish them from our EMS armamentarium.

Topics: Coma; Drug Combinations; Emergency Medical Services; Evidence-Based Medicine; Flumazenil; GABA Modulators; Glucose; Humans; Hypoglycemia; Naloxone; Narcotic Antagonists; Quality Assurance, Health Care; Thiamine; United States

Topics: Adrenergic alpha-Agonists; Brimonidine Tartrate; Coma; Dose-Response Relationship, Drug; Humans; Infant; Naloxone; Narcotic Antagonists; Quinoxalines; Treatment Failure

The aim of the present study was to test whether circadian differences in the response to opiates exist in humans and, if so, whether they are synchronized with the well-known circadian variations in overdose frequency.. Daily variations in opiate overdose frequency, total amount of naloxone necessary to treat the comatose state, and frequency of hospitalization were examined in pure, nonlethal, consecutive cases of opiate (presumably intravenous heroin) overdoses. Furthermore, daily variations in the frequency of lethal overdoses were examined in all cases observed during the same period.. An 8-yr prospective, observational study in the city and suburban area of Ferrara, Italy.. A total of 518 consecutive cases of nonlethal opiate overdoses in 327 different patients, plus 110 consecutive cases of lethal opiate overdoses with precise or presumptive time of death.. Analysis of the circadian distribution of nonlethal overdoses showed a significant peak in the afternoon to early evening. Analysis of the distribution of the hourly average amount of naloxone used to rescue patients from coma showed an opposite circadian variation, with a significant peak in the early morning. The hospitalization risk was also significantly higher from 3:00 to 8:59 am. However, in a subset of representative cases, plasma morphine concentrations did not change significantly in different hours of the day. Analysis of circadian distribution of lethal overdoses showed a significant peak in the evening hours. The death risk (calculated as the percentage of lethal events in the total number of intoxications within a given time frame) was significantly higher from 3:00 to 8:59 am.. The present data provide evidence for the existence of circadian variations in the individual sensitivity to opiate overdose.

Topics: Adult; Analysis of Variance; Circadian Rhythm; Coma; Drug Overdose; Female; Fourier Analysis; Humans; Italy; Male; Naloxone; Narcotic Antagonists; Narcotics; Odds Ratio; Prospective Studies; Risk

Topics: Adult; Anticonvulsants; Coma; Drug Overdose; Female; Glasgow Coma Scale; Humans; Naloxone; Narcotic Antagonists; Suicide, Attempted; Valproic Acid

Topics: Adult; Brain Ischemia; Cerebral Infarction; Coma; Drug Therapy, Combination; Emergency Medical Services; Female; Flumazenil; GABA Modulators; Glucose; Humans; Hypertonic Solutions; Naloxone; Narcotic Antagonists; Thiamine; Vasodilator Agents

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Coma; Drug Overdose; Female; Humans; Naloxone; Narcotic Antagonists; Olanzapine; Pirenzepine

Topics: Administration, Oral; Adult; Analgesics; Coma; Drug Combinations; Drug Overdose; Female; Humans; Naloxone; Respiratory Insufficiency; Suicide, Attempted; Tilidine

Stroke is an infrequent but recognized complication of heroin addiction. Two heroin addicts, aged 34 and 19 years, developed ballistic movements after intravenous heroin overdose. Patient 1 presented bilateral ballism 1 week after intravenous heroin injection. Magnetic resonance imaging (MRI) showed bilateral ischemic lesions of the globus pallidus, suggesting a generalized cerebral hypoxia during the comatose state as pathogenic mechanism. Patient 2 presented an acute left hemiballismus when consciousness was restored with naloxone. MRI demonstrated an ischemic infarct in the right striatum. An embolic mechanism of stroke was suspected in this patient, considering the normal results of blood analysis, echocardiogram and cerebral arteriograms. Ballistic movements ceased after administration of haloperidol; both patients remained without abnormal movements thereafter.

Topics: Adult; Anti-Dyskinesia Agents; Basal Ganglia; Brain Ischemia; Coma; Corpus Striatum; Drug Overdose; Globus Pallidus; Haloperidol; Heroin; Humans; Magnetic Resonance Imaging; Male; Movement Disorders; Naloxone; Narcotic Antagonists; Substance Abuse, Intravenous; Tomography, X-Ray Computed

A role for endogenous opioids in central nervous system disorders has often been proposed. A case report is presented of a 47-year-old male, medicated only with carbamazepine and lithium, who developed a precipitous alteration of consciousness (Glascow coma scale = 4). An extensive medical workup did not reveal an underlying cause. He exhibited a graded awakening with two intravenous doses of naloxone, which gradually reversed as the last naloxone dose was eliminated. Immunoassay and thin-layer chromatography of two urine samples (to evaluate the possibility of a medication error, alcohol ingestion, or illicit drug use) revealed only the presence of carbamazepine. A dysregulation of the endogenous opioid system is believed to underlie this episode.

Topics: Atrophy; Coma; Dose-Response Relationship, Drug; Drug Administration Schedule; Frontal Lobe; Glasgow Coma Scale; Humans; Infusions, Intravenous; Male; Middle Aged; Naloxone; Narcotic Antagonists; Neurologic Examination; Opioid Peptides

To determine whether clinical criteria (respirations of 12 or less, mitotic pupils, and circumstantial evidence of opiate abuse) could predict response to naloxone in patients with acute alteration of mental status (AMS) and to evaluate whether such criteria predict a final diagnosis of presence or absence of opiate overdose as accurately as response to naloxone.. Seven hundred thirty patients with AMS who received naloxone for diagnostic or therapeutic purposes at the discretion of two large, urban, paramedic base teaching hospitals.. We reviewed paramedic run sheets and audiotapes on all 730 patients as well as available hospital records of all patients who demonstrated any response to naloxone to determine whether overdose was responsible for their clinical presentations. We also reviewed hospital records for a selected sample of naloxone nonresponders.. Only 25 patients (3.4%) demonstrated a complete response to naloxone, whereas 32 (4.4%) manifested a partial or equivocal response. Nineteen of 25 complete responders (76%), two of 26 partial responders (8%) (with known final diagnosis), and four of 195 non-responders (2%) (with known final diagnosis) were ultimately diagnosed as having overdosed. Respirations of 12 or less or the presence of any one of the three clinical findings as a group were each highly sensitive in predicting response to naloxone, and at least as sensitive as response to naloxone in predicting a diagnosis of opiate overdose. Selective administration of naloxone for AMS would have decreased the use of this drug by 75% to 90% while still administering it to virtually all naloxone responders who had a final diagnosis of opiate overdose.

Topics: Clinical Protocols; Coma; Diagnosis, Differential; Drug Overdose; Emergency Medical Services; Evaluation Studies as Topic; Humans; Los Angeles; Naloxone; Narcotics; Reflex, Pupillary; Respiration; Sensitivity and Specificity

The records of 188 consecutive patients admitted for acute opiate intoxication were analyzed retrospectively to evaluate the morbidity and mortality of opiates. The most frequently used of these drugs were heroin (127 cases) and methadone (41 cases). In 79 cases the opiate was associated with another psychodepressant, usually benzodiazepines, alcohol or barbiturates. Forty-seven percent of the patients were admitted in deep coma, with respiratory arrest in almost every case. The complications observed in 49 patients were: aspiration of gastric contents (n = 24), rhabdomyolysis (n = 22), often associated with myocarditis (n = 13), pulmonary edema (n = 16), convulsions (n = 10), left ventricular dysfunction (n = 5) and lesions of the peripheral nervous system (n = 4). All patients survived, except one who died of cardiac arrest before admission. It is concluded that acute opiate intoxication treated in hospital has an excellent prognosis for life provided no cardiac arrest occurs prior to admission. One quarter of the patients require prolonged stay in an intensive care unit because of complications. The other patients, even when deeply comatose on admission, spend less than 1 day in hospital owing to the specific antagonist available.

Topics: Acute Disease; Adolescent; Adult; Cardiomyopathies; Coma; Drug Overdose; Female; Humans; Intensive Care Units; Lung Diseases; Male; Naloxone; Narcotics; Retrospective Studies; Rhabdomyolysis

Topics: Animals; Coma; Male; Morphine; Naloxone; Naltrexone; Narcotic Antagonists; Rabbits; Receptors, Opioid

Topics: Coma; Ethylene Glycols; Humans; Male; Middle Aged; Naloxone

A decreased level of consciousness with little abdominal pain or gastrointestinal symptoms is an uncommon, but well described, presentation of infantile intussusception. Its etiology is unclear. We describe a 10-month-old male who presented with coma and miosis, reversible with bolus injections of naloxone on three separate occasions. No opiates were involved and an intussusception was subsequently found. We speculate that the coma and miosis were induced by an endogenous opioid which could also mask the abdominal pain, thus explaining this presentation of intussusception. If so, miosis would be a valuable clue for diagnosing such children.

Topics: Coma; Endorphins; Humans; Infant; Intussusception; Male; Naloxone; Pupil

Topics: Coma; Emergencies; Heroin; Humans; Naloxone; Respiration, Artificial; Respiratory Insufficiency

Topics: Adult; Alcoholic Intoxication; Coma; Humans; Male; Naloxone; Narcotics; Substance-Related Disorders

A patient with seizures, coma and respiratory depression after pentazocine overdose was treated successfully with naloxone and artificial ventilation. Pentazocine is an antagonist of the mu opioid receptors and a partial agonist of the kappa and sigma receptors. Because naloxone has less affinity for kappa and sigma receptors than for mu receptors, larger doses of naloxone are frequently required in the treatment of pentazocine overdose. Our case lends support to the view that large doses of the narcotic antagonist naloxone may be effective in pentazocine overdose.

Topics: Adolescent; Coma; Female; Humans; Naloxone; Pentazocine; Respiration, Artificial; Respiratory Insufficiency; Seizures

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Coma; Diagnosis, Differential; Humans; Infant; Middle Aged; Naloxone; Poisoning

Topics: Adult; Coma; Humans; Hypnotics and Sedatives; Male; Meperidine; Naloxone; Physostigmine; Promethazine; Respiration; Sleep Apnea Syndromes

Topics: Adult; Coma; Female; Humans; Naloxone; Pregnancy; Puerperal Disorders

Thirteen patients with benzodiazepine overdosage received the specific benzodiazepine antagonist Ro 15-1788. Intravenous administration of 1.5 to 10 mg reversed the central nervous system depression induced by different benzodiazepine compounds within one to two minutes of injection. These case reports indicate that Ro 15-1788 may be an effective tool in the primary management of self-poisoning.

Topics: Adult; Aged; Anti-Anxiety Agents; Antidotes; Benzodiazepinones; Coma; Diazepam; Electroencephalography; Female; Flumazenil; Flunitrazepam; Humans; Male; Middle Aged; Naloxone; Suicide, Attempted

Topics: Acute Disease; Adult; Anesthesia, General; Anesthetics; Apnea; Coma; Fentanyl; Humans; Male; Muscle Rigidity; Naloxone; Postoperative Complications; Respiratory Insufficiency; Sufentanil; Time Factors

Topics: Central Nervous System; Child, Preschool; Chlorpromazine; Coma; Depression, Chemical; Gastric Lavage; Humans; Male; Naloxone

Topics: Coma; Drug Combinations; Humans; Naloxone; Narcotics; Opioid-Related Disorders; Pupil

In a 20 year old female nurse prolonged recovery (4 hours) unexpectedly followed to Rohypnol intoxication, the oral intake of which was realised only in the later period of postanaesthetic coma. Naloxone and physostigmine failed to achieve improvement but 4-aminopyridine was immediately successful.

Topics: 4-Aminopyridine; Adult; Aminopyridines; Anesthesia; Coma; Female; Flunitrazepam; Humans; Naloxone; Physostigmine; Postoperative Complications

Topics: Adult; Coma; Emergencies; Gastric Lavage; Humans; Male; Naloxone; Narcotics; Respiratory Insufficiency

A 65-year-old man showed naloxone-reversible unconsciousness followed by downward gaze paralysis. CT scan suggested an ischaemic lesion in the mesodiencephalic region. This observation represents the first case of naloxone-reversible coma related to brainstem ischaemia.

Topics: Aged; Brain Ischemia; Brain Stem; Coma; Humans; Male; Naloxone; Ophthalmic Nerve; Ophthalmoplegia; Tomography, X-Ray Computed

Topics: Alcoholic Intoxication; Coma; Double-Blind Method; Drug Evaluation; Humans; Naloxone; Random Allocation

A patient who ingested 1.5 g pentazocine developed status epilepticus, coma, respiratory depression, acidosis, profound hypotension, and ventricular arrhythmias. Although this patient survived after institution of general supportive measures, she did not respond to usual doses of naloxone. We describe the clinical symptoms and course of recovery of a patient with pentazocine overdose. Our case suggests that pentazocine overdose may require higher doses of naloxone (5 to 20 mg) than are customarily used for narcotic overdoses.

Topics: Acidosis; Arrhythmias, Cardiac; Coma; Critical Care; Electrocardiography; Female; Humans; Hypotension; Middle Aged; Naloxone; Pentazocine; Respiratory Insufficiency; Status Epilepticus; Substance-Related Disorders

Topics: Adolescent; Adult; Alcoholic Intoxication; Coma; Electroencephalography; Electrolytes; Ethanol; Hemodynamics; Humans; Middle Aged; Naloxone; Respiration

1 An assessment of the current role of naloxone in clinical toxicology has been made in a series of three separate epidemiological studies. 2 Through the National Poisons Information Service we found that the role of naloxone in opioid poisoning is often not appreciated by the enquirer and that toxicological screening is often requested before the diagnostic use of naloxone. 3 The recommended dose of naloxone (0.4--1.2 mg i.v.) is not always adequate. In 51 cases where naloxone was effective, doses of up to 3.2 mg were necessary (mean 1.8 +/- 0.3 mg SEM i.v.). 4 In 31 cases of non-opioid poisoning, naloxone in doses of 0.4--1.2 mg i.v. caused no deterioration, whilst six patients in whom no opioids were detected showed clinical improvement. 5 In 300 cases of suspected ethanol-induced coma, 49 showed reversal of coma with naloxone, and in 38 cases ethanol was the sole cause of coma (mean plasma concentration 3.54 +/- 0.62 g/l SEM). 6 These results suggest that the role of naloxone in clinical toxicology is not fully appreciated. There is a need for further education as to its indications in opioid poisoning, together with additional studies to define more accurately the dose/response relationship. In addition, the role of naloxone in coma induced by ethanol and certain other non-opioids needs to be evaluated further.

Topics: Alcoholic Intoxication; Coma; Hemodynamics; Humans; Naloxone; Narcotics; Poisoning; Respiration; Suicide, Attempted

Topics: Alcoholic Intoxication; Arousal; Coma; Drug Interactions; Humans; Naloxone; Shock

Topics: Apnea; Clonidine; Coma; Female; Humans; Infant; Naloxone

Topics: Adult; Alcoholic Intoxication; Coma; Female; Humans; Male; Naloxone

Topics: Alcoholic Intoxication; Animals; Coma; Dogs; Humans; Naloxone

Topics: Adolescent; Adult; Coma; Female; First Aid; Heart Failure; Humans; Male; Naloxone; Respiratory Insufficiency; Shock; Wounds and Injuries

Topics: Coma; Humans; Naloxone; Risk

Topics: Alcoholic Intoxication; Coma; Humans; Naloxone

Topics: Alcoholic Intoxication; Benzodiazepines; Coma; Drug Interactions; Ethanol; Humans; Naloxone

Topics: Atropine; Child, Preschool; Coma; Diphenoxylate; Drug Combinations; Humans; Isonipecotic Acids; Male; Naloxone; Respiratory Insufficiency

Topics: Adult; Alcoholic Intoxication; Coma; Female; Humans; Male; Naloxone

A specific arousal therapy with NAGD (Naloxone, Activated Charcoal, Glucagon, Doxapram) is outlined for victims of drug overdose in comatose and semi-comatose states. Several direct benefits accrue if early awakening or lightening of such patients is safely accomplished. There are: 1) elimination of need for prolonged intubation or tracheostomy; 2) patient's ability to tell which drug(s) were taken; 3) excessively frantic and vigorous supportive treatment is obviated; and 4) the overall hospital stay is shortened. The NAGD regimen has been found to effectively, safely, and predictably reverse coma. Therapy consists of: naloxone 0.8 mg to 1.6 mg intravenously; large-bore orogastric tube instillation of 100 gm to 120 gm activated charcoal slurry; glucagon 1 mg to 2 mg intravenously; and, in selected cases, doxapram 1 mg/kg to 2 mg/kg intravenously.

Topics: Charcoal; Coma; Doxapram; Drug Therapy, Combination; Glucagon; Humans; Injections, Intravenous; Naloxone; Substance-Related Disorders

Topics: Charcoal; Coma; Doxapram; Drug Administration Schedule; Glucagon; Humans; Naloxone; Poisoning

The use of naloxone, the first narcotic antagonist devoid of agonist properties, has become the standard way of treating narcotic-induced coma and respiratory depression. This report concerns a patient in whom a narcotic effect was unlikely, but who nevetheless showed arousal after naloxone administration.

Topics: Aged; Coma; Humans; Male; Naloxone

Topics: Adult; Alcoholic Intoxication; Coma; Evaluation Studies as Topic; Humans; Injections, Intravenous; Male; Naloxone

Topics: Adult; Alcoholic Intoxication; Antidotes; Coma; Ethanol; Humans; Injections, Intravenous; Male; Naloxone

As with any medical emergency, the initial approach to the management of the drug abuse emergency is to attend to the potential threat to life. Establish and maintain an adequate airway, with respiratory support if necessary: secure a reliable intravenous route: administer appropriate drugs and antidotes; and perform the necessary diagnostic procedures to identify the cause of the problem. Always make an assessment of the psychological threat of self-destruction before discharging a patient who has taken an overdose. Be suspicious of drug overdose ina comatose or oddly-behaving patient. Consider the possibility of multiple drug abuse. Finally, always consider the possibility that causes other than drugs may be producing these symptoms.

Topics: Central Nervous System; Coma; Depression, Chemical; Emergency Medical Services; Gastric Lavage; Humans; Naloxone; Psychotropic Drugs; Substance-Related Disorders; Suicide, Attempted

Narcotic analgesics and related drugs act as agonists on several receptors that are responsible for their effects on pain perception, mood and feeling state, and respiration, as well as other pharmacologic actions. Naloxone is the first discovered antagonist that is devoid of agonistic activity and appears to be a competitive antagonist at several receptors. The ability of naloxone to displace or prevent the binding of agonistic narcotics is partly responsible for its antagonistic effects. The ability of naloxone to rectify narcotic-depressed homeostats and precipitate abstinence is also related to its antagonistic activity. Certain cautions and principles apply in the use of naloxone in treating narcotic overdose, reversing surgical analgesia, and the treatment of neonates and children. Unapproved uses of naloxine include reversing the psychotomimetic effects of certain agonists-antagonists, terminating narcotic-induced convulsions and coma, reversing non-narcotic depression, diagnosing physical dependence, and treating narcotic addicts.

Topics: Adult; Analgesics; Animals; Child; Coma; Female; Guinea Pigs; Humans; Infant, Newborn; Infant, Newborn, Diseases; Mice; Naloxone; Narcotic Antagonists; Narcotics; Pregnancy; Receptors, Opioid; Respiratory Distress Syndrome; Seizures; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Coma; Dextropropoxyphene; Female; Humans; Infant; Methadone; Naloxone; Poisoning