naloxone and Poisoning

Poisonings, adverse drug effects, and envenomations continue to be commonly encountered. Patients often present critically ill and warrant ICU admission. Many other patients who are initially stable have the potential for rapid deterioration and require continuous cardiopulmonary and neurologic monitoring. Given the potential for rapid deterioration, and because patients need continuous monitoring, ICU admission is frequently required. This article is the first of a three-part series to be published in CHEST; it discusses general management, laboratory tests, enhanced elimination, and emerging therapies. The second article will address the management of specific overdoses; the last will cover plants, mushrooms, envenomations, and heavy metals.

Topics: Acid-Base Equilibrium; Acidosis; Fat Emulsions, Intravenous; Humans; Hydroxocobalamin; Intensive Care Units; Naloxone; Narcotic Antagonists; Neuroleptic Malignant Syndrome; Osmolar Concentration; Poisoning; Renal Dialysis; Serotonin Syndrome; Therapeutic Irrigation; Xenobiotics

Organophosphorus pesticide (OP) self-poisoning is a major problem in the developing rural world. There is little clinical trial data to guide therapy, hindering the identification of best therapy. Despite the recognition of adverse effects, gastric lavage is commonly done in Asia. We aimed to identify studies assessing its effectiveness.. We systematically searched the literature for controlled clinical studies that assessed the effect of gastric lavage in OP pesticide self-poisoning.. All 56 studies identified were Chinese and reported benefit from the intervention studied, including multiple gastric lavages, use of norepinephrine or pralidoxime in the lavage fluid, concurrent treatment with naloxone or scopolamine, insertion of the gastric tube via a laparotomy incision, and lavage later than 12 h post-ingestion. However, only 23 were RCTs and none presented adequate methodology for their quality to be assessed. The patient population and study treatment protocol were not defined - large variation in case fatality in the control arm of the studies (from 4.5 to 93%) suggests marked variation between studies and likely between study arms. No study compared an intervention against a control group receiving no gastric lavage or provided any data to indicate whether a significant quantity of poison was removed.. Despite widespread use of multiple gastric lavages for OP pesticide poisoning across Asia, there is currently no high-quality evidence to support its clinical effectiveness. There is a need for studies to identify in which patients and for what duration gastric lavage is able to remove significant quantities of poison. Following these studies, large clinical trials will be required to address the effectiveness and safety of gastric lavage (either single or multiple) in acute OP pesticide poisoning.

Topics: Adrenergic alpha-Agonists; Cholinesterase Reactivators; Diuretics; Gastric Lavage; Hospitalization; Humans; Hydrogen-Ion Concentration; Intubation, Gastrointestinal; Laparotomy; Mannitol; Naloxone; Narcotic Antagonists; Norepinephrine; Organophosphate Poisoning; Parasympatholytics; Pesticides; Plasma Exchange; Poisoning; Pralidoxime Compounds; Scopolamine; Time Factors

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

Topics: Bipolar Disorder; Female; Glasgow Coma Scale; Humans; Middle Aged; Naloxone; Poisoning; Renal Dialysis; Suicide, Attempted; Valproic Acid

A 57-year-old woman with metastasizing ovarian cancer and chronic renal failure was admitted for morphine treatment of an acute lumbospinal pain syndrome, ambulant treatment with analgesics having failed provide adequate pain relief. On admission due to pain the conscious patient presented with reduced general condition and lumbal pain sensitive to tapping. Lasègue's sign was positive on both sides, no other disturbed neurological functions were found.. On the 7th day of morphine administration she became somnolent and breathing became markedly depressed, indicating overdosage, metabolic and intracranial causes having been excluded. Naloxone, an opioid antagonist, was given i.v. and the breathing pattern improved. But drowsiness continued for another 48 hours and only regressed after repeated doses of naloxone.. Morphine-6-glucuronide (M6G), formed from morphine in the liver, accumulates in blood and penetrates the blood-brain barrier, binding with strong affinity to opiate receptors and exerts a strong analgesic effect. As M6G is excreted by the kidney, its concentration rises in renal failure and can lead to severe intoxication. Morphine dosage must therefore be carefully controlled in patients with renal failure.

Topics: Analgesics, Opioid; Diagnosis, Differential; Female; Humans; Kidney Failure, Chronic; Middle Aged; Morphine; Morphine Derivatives; Naloxone; Narcotic Antagonists; Ovarian Neoplasms; Pain, Intractable; Poisoning

Poisonings are a common problem. In 1995, over 2 million exposures were reported to American poison information centres alone. The majority of poisoning exposures can be treated without major therapeutic intervention. If therapy is indicated, it is usually in the form of gastrointestinal decontamination with activated charcoal, to prevent absorption of the toxin and the subsequent toxicity that may occur. In a limited number of cases, more aggressive life-support measures may be necessary to treat the adverse effects of poisons. Occasionally, that intervention may include the use of pharmacological antagonists, more commonly referred to as antidotes. According to the American Association of Poison Control Centers, the most commonly used antidotes are acetylcysteine, naloxone, atropine, deferoxamine (desferrioxamine) and antivenins. Overall, 17 antidotes account for 99% of all antidote use and those agents are reviewed in this article. With the exception of naloxone, most antidotes have pharmacological effects that are independent of their inherent antidotal properties. Therefore, antidotes should be used judiciously because their pharmacological properties may exacerbate pre-existing toxicity and only in rare circumstances are they used prophylactically. Some antidotes, such as digoxin-specific antigen binding fragments (digoxin immune Fab), are very expensive, and both the risk: benefit ratio and the associated cost should be considered before the antidote is administered. The principle aims are to "treat the patient, not the poison' and to do no harm to the patient. Antidotes should be used only when they are indicated and may help a patient.

Topics: Acetylcysteine; Antidotes; Antivenins; Atropine; Deferoxamine; Flumazenil; Humans; Hydroxocobalamin; Naloxone; Physostigmine; Poisoning; Succimer

To describe the epidemiology of clonidine-related hospitalization in children, to evaluate the efficacy of naloxone, and to review the clinical effects of clonidine toxicity.. This was a retrospective analysis in an urban teaching pediatric emergency department with an annual census of 55,000 involving 80 children younger than 6 years who were admitted for clonidine ingestion during a 6-year period.. Clonidine commonly belonged to the patient's grand-mother (54%). Black children were twice as likely to be hospitalized for clonidine ingestion than white children compared with children hospitalized for any injury. Average time to onset of symptoms was 35 minutes. Decreased level of consciousness was the most common presenting symptom (96%). Mean ED vital signs were systolic blood pressure, 102 mm Hg; pulse, 98; respirations, 25 (six patients intubated); and temperature, 36.6 degrees C, Naloxone was administered to 49% of patients, 84% of whom demonstrated no response.. Clonidine ingestion is endemic in our area. Serious clinical effects mandate that all children with clonidine ingestion be triaged to a health care facility. Naloxone as an antidote for clonidine remains controversial.

Topics: Alabama; Antihypertensive Agents; Black or African American; Child, Preschool; Clonidine; Female; Humans; Infant; Male; Naloxone; Narcotic Antagonists; Poisoning; Retrospective Studies

In the assessment and management of the potentially poisoned patient with altered consciousness, the most consequential and controversial interventions occur during the first 5 minutes of care. In this review article, the risks and benefits of standard diagnostic and therapeutic interventions are presented to guide clinicians through this critical period of decision making.. Data for discussion were obtained from a search of English-language publications referenced on MEDLINE for the years 1966 to 1994. Older literature was included when pertinent. Search terms included poisoning, overdose, toxicity, naloxone, glucose, thiamine, and flumazenil.. Only large trials were used for determinations of diagnostic utility and efficacy. Small trials, case series, and case reports were reviewed extensively for adverse effects.. Trials were reviewed for overall methodology, inclusion and exclusion criteria, sources of bias, and outcome.. Analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Although rapid reagent test strips can be used to guide this therapy, they are not infallible, and they fail to recognize clinical hypoglycemia that may occur without numerical hypoglycemia. Administration of naloxone hydrochloride should be reserved for patients with signs and symptoms of opioid intoxication. Flumazenil is best left for reversal of therapeutic conscious sedation and rare select cases of benzodiazepine overdose.

Topics: Consciousness; Flumazenil; Glucose; Humans; Naloxone; Poisoning; Thiamine

Naloxone has enjoyed long-standing success as a safe and effective opioid antagonist and has been invaluable in defining the role of endogenous opioid pathways in the response to pathological states such as sepsis and hypovolemia. We look forward to exciting research to further elucidate these pathways and to improve outcome by modulating the patient's physiological response to these stresses.

Topics: Acute Disease; Adult; Animals; Asphyxia Neonatorum; Cerebrovascular Disorders; Child; Emergency Medicine; Humans; Infant, Newborn; Naloxone; Poisoning; Shock; Spinal Cord Injuries; Treatment Outcome

Dextromethorphan, a common ingredient in cough syrups, has rarely been described to cause toxicity. The authors describe an unusual case of a known asthmatic presenting with somnolence, who appeared to be in end-stage respiratory failure. Her partial response to routine naloxone, 1 mg, was surprising. However, additional naloxone was required to completely normalize the patient's mental status. The authors suggest naloxone be administered in doses of 0.4 mg or more intravenously in suspected dextromethorphan overdose.

Topics: Adolescent; Adult; Antidotes; Antitussive Agents; Child, Preschool; Dextromethorphan; Drug Overdose; Female; Humans; Infant; Male; Naloxone; Poisoning

Substance abuse is a significant health problem in the adolescent population. Prevention is a formidable challenge, but attempts at discouraging experimentation in early adolescence and the promotion of healthy adult role models may be effective strategies. Questions that may elicit a history suggestive of abuse should be a routine part of the adolescent medical history. Pediatricians should be familiar with the important clinical findings resulting from intoxication with the various substances of abuse and should be able to recognize the "telltale" signs of abuse. Effective management is based on attention to the basics of life support, careful attention to the physical findings, and judicious use of specific therapeutic agents. Above all, a compassionate attitude should prevail if acute-phase recovery and long-term rehabilitation are to be successful.

Topics: Absorption; Adolescent; Adult; Alcoholic Intoxication; Amphetamines; Anti-Anxiety Agents; Benzodiazepines; Cocaine; Diagnosis, Differential; Female; Fever; Glucose; Hallucinogens; Humans; Hypotension; Illicit Drugs; Lysergic Acid Diethylamide; Marijuana Abuse; Mescaline; Methaqualone; Mushroom Poisoning; Naloxone; Narcotics; Nitrites; Poisoning; Solvents; Substance-Related Disorders

Topics: Acetaminophen; Acetylcysteine; Antidotes; Charcoal; Chemical and Drug Induced Liver Injury; Child Abuse; Child, Preschool; Digitoxin; Digoxin; Emetics; Female; Gastric Lavage; Humans; Hydrocarbons; Immunoglobulin Fab Fragments; Infant; Male; Naloxone; Narcotics; Poisoning

Topics: Administration, Oral; Antidotes; Deferoxamine; Dimercaprol; Hot Temperature; Humans; Injections, Intramuscular; Kinetics; Naloxone; Penicillamine; Physical Exertion; Poisoning; Pralidoxime Compounds; Thiamine

New data are reviewed in two areas in the management of the acute overdose: gastrointestinal decontamination and systemic antidotes. The mechanism and effectiveness of Ipecac syrup, gastric aspiration and lavage, activated charcoal, gastrointestinal dialysis, and saline cathartics are discussed. Special problems posed by disc batteries and packet ingestion of cocaine (in transporting contraband) are highlighted. The pharmacology and uses of pyridoxine and naloxone as antidotes are detailed.

Topics: Antidotes; Cathartics; Charcoal; Child; Cocaine; Deglutition; Foreign Bodies; Gastric Lavage; Humans; Ipecac; Isoniazid; Naloxone; Narcotics; Poisoning; Pyridoxine; Substance-Related Disorders; Suction; Time Factors; Toxicology; Vomiting

The author reviews obscure or unusual antidote recommendations, emphasizing antidotes or antidote uses that are not generally acknowledged or that have little experimental or clinical confirmation of their efficacy. Also included are unusual uses of well known antidotes. Among the antidotes considered are naloxone, physostigmine, folate, Prussian blue, n-acetylcysteine, cimetidine, subcutaneous magnesium salts, nicotinamide, and thioctic acid.

Topics: Acetylcysteine; Adult; Aged; Animals; Antidotes; Child; Cimetidine; Female; Ferrocyanides; Folic Acid; Heart Diseases; Humans; Magnesium; Male; Middle Aged; Naloxone; Niacinamide; Physostigmine; Poisoning; Pyridoxine; Thioctic Acid

Topics: Anesthetics; Animals; Arousal; Cerebrovascular Circulation; Cerebrovascular Disorders; Child, Preschool; Female; Gerbillinae; Humans; Male; Middle Aged; Naloxone; Poisoning; Rats; Respiration; Respiratory Insufficiency; Shock, Septic; Spinal Cord Injuries

Topics: Administration, Oral; Apgar Score; Birth Weight; Child; Child Care; Female; Gestational Age; Heroin Dependence; Humans; Infant, Newborn; Levallorphan; Maternal-Fetal Exchange; Methadone; Nalorphine; Naloxone; Phenobarbital; Poisoning; Pregnancy; Substance Withdrawal Syndrome; Tablets

Naloxone, as a low-priced and available drug, may be useful in improvement of signs and symptoms of benzodiazepines intoxication. The aim of this study was assessment of its effect on benzodiazepines poisoning.. In this clinical-trial study, patients with typical signs and symptoms of benzodiazepines poisoning, who were referred to a poisoning center in Tehran in 2008, were selected. After recording of patients' characteristics, supportive treatment was initiated and patients were randomly assigned to the case group with intravenous (IV) injection of two 0.4 mg naloxone ampules or to the control group. Their signs and symptoms were evaluated again 0.5 hour later. Each of diazepam, clonazepam and alperazolam drug group had 30 patients and lorazepam drug group had 26 patients, half of which patients in each drug group received naloxone.. Most of the participants were female and the mean age was 28 years. There were no significant differences between case and control groups in age, sex, time of drug consumption, tablet counts, signs and symptoms and level of consciousness at the admission time in each drug types. After naloxone injection in case groups, all signs and symptoms significantly improved in all drug types in comparison to control groups except nystagmus. In addition, level of consciousness significantly improved in case groups in all drug types except lorazepam.. Findings of the study showed that naloxone is effective in management of benzodiazepines poisoning. However, future clinical trials with greater sample size are recommended.

Topics: Adult; Benzodiazepines; Female; Humans; Hypnotics and Sedatives; Male; Naloxone; Narcotic Antagonists; Poison Control Centers; Poisoning; Treatment Outcome; Unconsciousness

Acute poisonings with drugs of abuse in Poland in 1995 made up 3-4% of all cases of intoxications. In Kraków the most common cause of drug addiction resulting in life threatening states is the use and abuse of opiates derivatives produced by drug addicted people themselves. This domestic product, so called "kompot" or Polish heroin is produced from poppy straw or juice of poppy head (Papaver somniferum). "Kompot" shows the variable contents of heroin, 6-MAM, 3-MAM, morphine, acetylocodeine and codeine. Papaverine, thebaine and narcotine were also detected. The aim of the study was to investigate the frequency of application and the efficiency of naloxone in the treatment of acute poisonings with "kompot" in the subculture of Kraków drug abusers. 91 patients were treated in the Department of Toxicology in 1996 from the acute poisoning with "kompot". There were 24% of women and 76% of men. The age average was 25.2 years. In 61.5% of cases patients intake only "kompot", in 27.5% "kompot", benzodiazepines and barbiturates, in 6.6% "kompot" and amphetamine and only in 4.4% "kompot" with ethanol. In 10% of poisoned naloxone was applied only at the place of accident. In 58% only in the Department of Toxicology. 32% were treated with naloxone both at the place of accident and in the Department of Toxicology. At the place of accident in most cases the single dose was usually applied (mean dose 0.48 mg) and 76% of patients required the additional treatment with naloxone after the admission (mean dose 1.92 mg). Only 5.5% of acute intoxicated with kompot" drug abusers needed intensive care treatment. Complications in the form of vomiting and excitement were a rare case-5.5%.

Topics: Adolescent; Adult; Female; Humans; Incidence; Male; Naloxone; Narcotic Antagonists; Narcotics; Poisoning; Poland; Substance-Related Disorders

Topics: Humans; Naloxone; Narcotic Antagonists; Poisoning

We aimed to describe the severity of clonidine poisonings in a paediatric population referred to a tertiary toxicology service.. We undertook a retrospective review of all presentations of clonidine poisoning in children or adolescents reported to a tertiary toxicology service from March 2014 to February 2020. Cases were divided into young children (0-6 years), older children (7-11 years) and adolescents (12-17 years). We report clinical effects: bradycardia, hypotension and abnormal Glasgow coma score (GCS), based on standard paediatric observation charts, interventions, length of emergency department stay, proportion admitted to a medical ward or paediatric intensive care unit.. We identified 111 clonidine poisonings, 41 young children, 9 older children and 61 adolescents. There were more females in the adolescent group and slightly more males in the younger age groups. The median dose ingested was 13 mcg/kg (interquartile range: 7-38 mcg/kg), which varied across ages. Clonidine alone was ingested in 78 cases (70%) and co-ingestion was more common in adolescents (24/61; 39%). Thirty-seven patients (33%) were admitted and 23 (21%) were admitted to paediatric intensive care unit. Median length of emergency department stay was 16.4 h, longer for adolescents. At least one abnormal observation occurred in 101 of 111 (91%) cases: 76 of 106 (72%) bradycardia, 76 of 110 (69%) hypotension and 4 of 99 (4%) GCS < 9. Thirteen (12%) had severe bradycardia, more common in young children and 23 (21%) had severe hypotension, more common in adolescents. For 27 children (0-11 years) ingesting 5-10 mcg/kg, 3 (11%) had severe bradycardia or severe hypotension and 1 received naloxone (4%). No cases ingesting <5 mcg/kg developed moderate/severe bradycardia or hypotension. Four cases received naloxone with no significant change, two patients got atropine with a transient response. One patient was intubated to facilitate safe inter-hospital transfer.. Paediatric clonidine poisoning commonly results in bradycardia, hypotension and decreased GCS, but rarely severe or requiring major interventions. Children ingesting <5 mcg/kg do not require admission.

Topics: Adolescent; Atropine; Bradycardia; Child; Child, Preschool; Clonidine; Female; Humans; Hypotension; Male; Naloxone; Poisoning; Retrospective Studies

Opioid-related harm has risen in recent decades, but limited research describes the clinical burden of opioid poisoning to Australian EDs. We aimed to investigate hospital presentations with opioid poisoning over three decades.. This is an observational series of prospectively collected data investigating presentations of opioid poisoning to an ED in Newcastle (1990-2021). Type of opioid, naloxone administration, intubation, intensive care unit (ICU) admission, length of stay and death were extracted from the unit's database.. There were 4492 presentations in 3574 patients (median age 36, 57.7% female), increasing from an average of 93 presentations annually in the first decade to 199 in the third decade. Deliberate self-poisonings accounted for 3694 presentations (82.2%). Heroin dominated the 1990s, peaking in 1999 before decreasing. Prescription opioids then rose, with codeine (usually in paracetamol combination) predominating until 2018, after which oxycodone presentations exceeded them. Methadone consistently increased from six presentations annually in the first decade to 16 in the last decade. Naloxone was administered in 990 (22.0%) presentations and 266 (5.9%) were intubated, most frequently following methadone and heroin exposures. ICU admissions increased from 5% in 1990 to 16% in 2021. Codeine exposures resulted in less severe effects, whereas methadone had more severe effects overall. The median length of stay was 17 h (interquartile range 9-27 h). There were 28 deaths (0.6%).. Opioid presentations increased in number and severity over three decades as the type of opioid changed. Oxycodone is currently the main opioid of concern. Methadone poisoning was the most severe.

Topics: Adult; Analgesics, Opioid; Australia; Codeine; Female; Heroin; Humans; Male; Methadone; Naloxone; Oxycodone; Poisoning; Prescriptions

The prevalence of poisoning from methadone and prescription opioids is increasing in pediatric populations. Naloxone is the main antidote for treatment. Long-acting opioid toxicity may need close observation in the intensive care unit (ICU). In our previous study, naltrexone prevented re-narcotization in methadone-poisoned adults. Here, we aim to share our experience with the use of oral naltrexone for preventing recurrence of toxicity in opioid-naïve children.. In a single-center, retrospective case series, children (age ≤12 years) admitted to a poison center in Tehran (Iran) between March 2014-March 2016 were included if they presented with methadone poisoning and received naltrexone treatment in hospital. Naltrexone (1 mg/kg) was administrated orally after initial administration of 0.1 mg/kg naloxone intravenously. Children were monitored for level of consciousness, cyanosis, respiratory rate, VBG results, and O2 saturation for ≥48 h during their hospitalization.. Eighty patients with methadone poisoning were enrolled, with median age of three years (range: 0.2-12.0). None involved polysubstance poisoning. Following naltrexone treatment, none experienced recurrent opioid toxicity during hospitalization, and hospital records indicated no readmission within 72-h post-discharge.. Oral naltrexone could be a potential substitute for continuous naloxone infusion in methadone-poisoned children and reduce the need for ICU care.

Topics: Adolescent; Aftercare; Analgesics, Opioid; Child; Child, Preschool; Female; Hospitalization; Humans; Infant; Intensive Care Units; Iran; Male; Methadone; Naloxone; Naltrexone; Narcotic Antagonists; Narcotics; Neoplasms; Patient Discharge; Poisoning; Recurrence; Retrospective Studies

France is experiencing an increase in the number of opioid prescriptions and related fatalities. We carried out a retrospective observational study using data from the Paris PCC over a 10-year period. The main objective was to obtain an epidemiological description of the severe reported cases. The secondary objectives were to assess the evolution of the number of these cases and their severity defined by the use of fentanyl and its derivatives, the use of the opioid-poisoning treatment naloxone, and the number of fatalities. During 2008-2017, 268 511 cases were recorded, including 1 122 cases of opioid-related poisoning that required medical management. These poisonings involved tramadol (43%), codeine (25%), dextropropoxyphene (13%), and morphine (8%); most resulted from self-exposure (60%). During the 10-year study period, 130 opioid-related fatalities were recorded in the Paris area, mainly resulting from suicides (39%) in men and were attributed to morphine (27%), tramadol (24%), and methadone (21%). We did not identify an increase in the number of severe opioid-related poisonings or fatalities or in the use of fentanyl or its derivatives. Conversely, we observed an increase in the use of naloxone, suggesting an increase in the severity of opioid poisonings. Our findings show that, until 2017, the opioid overdose epidemiology in the Paris area is different to that in the USA. The systematic analysis of data from the PCCs could be a good tool for health monitoring. To assess trends in France, a national study over a longer period would also be useful.

Topics: Adolescent; Adult; Analgesics, Opioid; Cause of Death; Drug Prescriptions; Female; Humans; Male; Middle Aged; Naloxone; Narcotic Antagonists; Opioid-Related Disorders; Paris; Poison Control Centers; Poisoning; Retrospective Studies; Suicide; Time Factors; Young Adult

Topics: Benzodiazepines; Humans; Naloxone; Narcotic Antagonists; Poisoning

Topics: Benzodiazepines; Female; Humans; Hypnotics and Sedatives; Male; Naloxone; Narcotic Antagonists; Poisoning

Topics: Analgesics, Opioid; Drug Approval; Drug Prescriptions; Drug Users; Emergency Responders; Health Policy; Humans; Naloxone; Narcotic Antagonists; Poisoning; Practice Patterns, Physicians'; Prescription Drug Misuse; Risk; United States; United States Food and Drug Administration

Topics: Benzodiazepines; Blood Chemical Analysis; Humans; Naloxone; Narcotic Antagonists; Poisoning; Receptors, GABA; Self Report; Substance Abuse Detection

Fentanyl is a synthetic opioid available therapeutically as an intravenous, transbucal, or transdermal preparation. It is also used as a drug of abuse through a variety of different methods, including the oral abuse of transdermal fentanyl patches. This is a series of patients with oral fentanyl patch exposure reported to our center and represents the first series of oral fentanyl patch exposures collected outside of the postmortem setting.. In this series, we examined the New York Poison Control Center database for all cases of oral abuse of fentanyl reported between January 2000 and April 2008.. Twenty cases were reported, nine were asymptomatic or had symptoms of opioid withdrawal; 11 had symptoms of opioid intoxication. Eight patients were administered naloxone and all showed improvement in clinical status. Only one case resulted in a confirmed fatality-this patient had an orally adherent patch discovered at intubation.. Oral exposure may result in life-threatening toxicity. Patients should be closely assessed and monitored for the opioid toxidrome, and if symptomatic, should be managed with opioid antagonists and ventilatory support.

Topics: Administration, Oral; Adult; Analgesics, Opioid; Databases, Factual; Female; Fentanyl; Humans; Male; Middle Aged; Naloxone; Narcotic Antagonists; Poisoning; Respiration, Artificial; Substance-Related Disorders; Suicide, Attempted; Transdermal Patch; Treatment Outcome

Despite extensive educational and preventive efforts, fatality from poisoning is a growing public health concern. While strategies to reduce fatal unintentional poisoning in children have been largely successful, growing numbers of deaths from suicidality and substance abuse present unique challenges to the public health system. This paper explores three areas where new approaches hope to mitigate major causes of poison-related fatality. Included in this discussion are bystander naloxone for opioid overdose, a reconsideration of the optimal dose of N-acetylcysteine therapy and intravenous fat emulsion (lipid rescue) therapy for cardiovascular toxins. These innovative approaches are designed to challenge dogma and provide a stimulus for individualised clinical care.

Topics: Acetylcysteine; Animals; Antidotes; Child; Fat Emulsions, Intravenous; Humans; Naloxone; Poisoning; Risk Factors; Substance-Related Disorders; Suicide

Brimonidine tartrate, a centrally acting selective alpha-2 adrenergic agonist with a toxicity that is often compared with that of clonidine, is used as eye drops to lower intraocular pressure in glaucoma. We investigated characteristics of childhood exposures to brimonidine-containing products.. All brimonidine exposures in children 0 to 5 years of age between 1997 and 2005 were retrieved from the American Association of Poison Control Centers' Toxic Exposure Surveillance System database and the US Food and Drug Administration's Medwatch Adverse Events Reporting System. The design of the study was retrospective, and the main outcome measures were frequency of exposures over time, reason, symptoms/signs of toxicity, dose, management site, treatment, and outcome.. There were 413 brimonidine reports in the Toxic Exposure Surveillance System and 340 in the Adverse Events Reporting System during the 9 years under study, of which 185 Toxic Exposure Surveillance System reports involved children < or =5 years of age versus 15 cases in the Adverse Events Reporting System. There were no deaths. The peak age of poisoning in the Toxic Exposure Surveillance System pediatric cases was 2 years of age, and circumstances were unintentional poisoning in 176 cases, usually by ingestion (84.3%). Common symptoms in 176 children included drowsiness (40.9%), ataxia (4.5%), pallor (4.5%), irritability (4.0%), hypotension (4.0%), bradycardia (4.0%), miosis (3.4%), and respiratory depression (3.4%). Of the 176 unintentional pediatric poisonings, 73 children were observed at home and 103 were seen at a health care facility; 28 were hospitalized and 11 received naloxone. Of the 15 pediatric cases in the Adverse Events Reporting System data set, all were hospitalized, and 13 had ocular exposures only.. All children < or =5 years of age with confirmed brimonidine ingestions should be medically evaluated and monitored for an extended period. Indications for the use of naloxone in brimonidine poisoning remain uncertain.

Topics: Adrenergic alpha-Agonists; Brimonidine Tartrate; Child, Preschool; Humans; Infant; Naloxone; Poisoning; Quinoxalines; Retrospective Studies

The medical outcome of heroin body stuffers has rarely been described. This study was performed to illustrate the clinical course of heroin body stuffers. A retrospective chart analysis was performed on all cases of heroin body stuffers received by a metropolitan poison control center from 2000-2004. We identified 65 heroin body stuffers. Sixty-nine percent were men with a mean age of 35 years. The stated quantity of heroin containers ingested ranged from 1 to 30, with 65% reported as being wrapped in plastic. Six patients (9.2%) developed symptoms of opiate intoxication. All symptoms began within an hour after the ingestion. Three patients (4.6%) needed naloxone. The mean length of observation was 24 h. Opiate intoxication from heroin stuffing is uncommon. Those patients that developed symptoms did so early in their course. These data indicate a benign clinical course in most heroin body stuffers.

Topics: Adult; Antidotes; Charcoal; Combined Modality Therapy; Commerce; Eating; Endoscopy; Female; Heroin; Humans; Male; Naloxone; Narcotic Antagonists; Poisoning; Therapeutic Irrigation; Time Factors

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

Methadone, the most widely delivered maintenance therapy for heroin addicts, may be responsible for life-threatening poisonings with respiratory depression. The toxicokinetics and the toxicokinetic/toxicodynamic (TK/TD) relationships of methadone enantiomers have been poorly investigated in acute poisonings. The aim of this study was to describe the relationships between methadone-related respiratory effects and their corresponding concentrations.. We report a 44-year-old methadone-maintained patient who ingested a 240-mg dose of methadone. He was found comatose with pinpoint pupils and respiratory depression. He was successfully treated with intravenous naloxone infusion over the course of 31 hours at a rate adapted to maintain normal consciousness and respiratory rate. We performed a TK/TD analysis of the naloxone infusion rate needed to maintain his respiratory rate at more than 12 breaths per minute (as toxicodynamics parameter) versus plasma R,S- and R-methadone concentrations (as toxicokinetics parameter), determined using an enantioselective high-performance liquid chromatography assay.. Initial plasma R,S-methadone concentration was 1,204 ng/ml. Decrease in plasma R- and S-methadone concentrations was linear and demonstrated a first-order pharmacokinetics (maximal observed concentrations 566 and 637 ng/ml, half-lives 16.1 and 13.2 hours, respectively). TK/TD correlation between naloxone infusion rate and R,S- and R-methadone concentrations fitted well a sigmoidal Emax model (concentration associated with a half-maximum effect [EC50] 334 and 173 ng/ml, Hill coefficient 10.0 and 7.8, respectively). In our chronically treated patient, EC50 values were in the range of previously reported values regarding methadone analgesic effects, suggesting that plasma methadone concentrations to prevent withdrawal are lower than those associated with methadone analgesic effects.. After the ingestion of a toxic dose of a racemic mixture, plasma R- and S-enantiomer concentrations decreased in parallel. Despite large inter-individual variability in methadone toxicokinetics and toxicodynamics, TK/TD relationships would be helpful for providing quantitative data regarding the respiratory response to methadone in poisonings. However, further confirmatory TK/TD data are needed.

Topics: Adult; Chromatography, High Pressure Liquid; Drug Monitoring; Humans; Infusions, Intravenous; Isomerism; Male; Methadone; Naloxone; Narcotic Antagonists; Narcotics; Poisoning; Respiration; Respiratory Insufficiency

Topics: Child, Preschool; Female; Humans; Infusions, Intravenous; Male; Methadone; Naloxone; Narcotic Antagonists; Narcotics; Poisoning

A 76-year-old woman being treated with sodium valproate for bipolar depression presented with a 4 day history of acute confusion and tremulousness. She had apnoeic episodes, reduced conscious level and generalised myoclonic movements. Her plasma valproate concentration was 848 micromol/l (normal 300-600 micromol/l). Administration of naloxone 0.8 mg led to rapid clinical improvement. Naloxone may be useful in reversing the features of chronic valproate toxicity.

Topics: Aged; Antimanic Agents; Bipolar Disorder; Female; Humans; Naloxone; Narcotic Antagonists; Poisoning; Valproic Acid

Topics: Buprenorphine; Humans; Infant; Naloxone; Narcotic Antagonists; Poisoning

Buprenorphine in sublingual formulation was recently introduced to the American market for treatment of opioid dependence. We report a series of 5 toddlers with respiratory and mental-status depression after unintentional buprenorphine exposure. Despite buprenorphine's partial agonist activity and ceiling effect on respiratory depression, all children required hospital admission and either opioid-antagonist therapy or mechanical ventilation. Results of routine urine toxicology screening for opioids were negative in all cases. Confirmatory testing was sent for 1 child and returned with a positive result. The increasing use of buprenorphine as a home-based therapy for opioid addiction in the United States raises public health concerns for the pediatric population.

Topics: Analgesics, Opioid; Buprenorphine; Consciousness Disorders; Female; Humans; Infant; Male; Naloxone; Narcotic Antagonists; Poisoning; Respiration, Artificial; Respiratory Insufficiency

Topics: Analgesics, Opioid; Central Nervous System Diseases; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Miosis; Morphine; Naloxone; Oxycodone; Poisoning; Respiratory Insufficiency; Siblings; Treatment Outcome

Topics: Analgesics, Opioid; Diphenoxylate; Humans; Naloxone; Narcotic Antagonists; Poisoning

In this article we described a 15-year-old female who was admitted to the Clinic of Toxicology because of suicidal, oral intoxication with morphine sulphate in the total dosage of 360 mg. In the Clinic the patient was in I degree degree of Matthew coma scale, with the heart rate about 90/min., blood pressure 105-100/70-60 mmHg, breath rate about 7/min. The arterial blood gas analysis showed acute respiratory failure (pCO2 64.1 mmHg, pO2 54.9 mmHg and SO2 88%) in spite of constant and intravenous Naloxone infusion. The mother of the patient, who was a nurse, had not agreed to endotracheal intubation and invasive method of respiration. Because of that reason the non invasive positive pressure ventilation with the BiPAP Synchrony apparatus were used with IPAP 14 cm H2O, EPAP 5 cm H2O, breath rate 12/min, time of inspiration 2.0 sek., time of inspiration grow 600 msek. After 15 minutes of respiration pCO2 decreased up to 40 mmHg, pO2 increased up to 73.3 mmHg and the oxygen saturation of arterial blood was 95.7-98.6%. Respiratory failure was observed every time when apparatus was withdrawn. After 24 hours of ventilation by BiPAP Synchrony apparatus the full stabilization of respiratory tract was achieved.

Topics: Acute Disease; Administration, Oral; Adolescent; Drug Overdose; Female; Humans; Morphine; Naloxone; Narcotic Antagonists; Narcotics; Poisoning; Positive-Pressure Respiration; Respiratory Insufficiency; Suicide, Attempted

Topics: Adult; Analgesics, Opioid; Etorphine; Humans; Injections; Male; Naloxone; Narcotic Antagonists; Poisoning; Respiration, Artificial

We report a 3-y-o boy who accidentally poisoned himself with valproic acid (VPA). Clinical features included profound coma, depressed respiration and miosis. Treatment included naloxone, gastric lavage, and activated charcoal and a saline cathartic. The patient fully recovered and was discharged 24 h after the admission. Prompt use of naloxone is advised whenever the triad of coma, pinpoint pupils and depressed respiration concur with the clinical possibility of VPA intoxication.

Topics: Child, Preschool; Diagnosis, Differential; Drug Overdose; Gastric Lavage; Humans; Male; Naloxone; Opioid-Related Disorders; Poisoning; Treatment Outcome; Valproic Acid

Topics: Acute Disease; Adult; Depressive Disorder; Humans; Male; Methadone; Naloxone; Narcotic Antagonists; Narcotics; Poisoning; Suicide, Attempted

Topics: Analgesia; Child; Clinical Competence; Conscious Sedation; Humans; Immobilization; Naloxone; Narcotic Antagonists; Narcotics; Poisoning

The purpose of this study was to determine if emergency medical services (EMS) providers routinely initiate field gastrointestinal decontamination of adult drug overdose patients transported to the emergency department (ED). A retrospective prehospital chart review was performed on adult patients identified as drug overdose who were transported by EMS. ED charts on patients transported to a university hospital were reviewed for follow-up data. Prehospital care records showed that gastrointestinal decontamination was initiated in only 6 of 361 (2%) patients, all of whom received ipecac. No patient received activated charcoal. The median transport time was 25 minutes (range, 5 to 66 minutes). Follow-up data on patients transported to the university hospital revealed that 30 of 43 (70%) patients who might have been suitable candidates for prehospital activated charcoal actually received activated charcoal in the ED. Median time to activated charcoal in the ED was 82 minutes (range, 32 to 329 min). Use of activated charcoal in the field appears to be deferred despite its known loss of efficacy over time. The failure to start activated charcoal in the field contributes to the delay in initiating activated charcoal therapy.

Topics: Administration, Oral; Adult; Antidotes; Charcoal; Digestive System; Drug Overdose; Emergency Medical Services; Emetics; Feasibility Studies; Female; Follow-Up Studies; Hospitals, University; Humans; Ipecac; Male; Naloxone; Narcotic Antagonists; New York; Poisoning; Retrospective Studies; Single-Blind Method; Sorption Detoxification; Time Factors

To determine the frequency and potential predictors of opioid toxicity recurrence after a response to naloxone in adult Emergency Department patients.. A retrospective case-control study of naloxone-treated patients with opioid toxicity over an 8-year period. Both the patient response to naloxone and recurrence of opioid toxicity was determined by an expert Delphi Panel. The frequency of opioid toxicity recurrence was compared by the duration of opioid effect, the route of opioid exposure, and the presence of other CNS depressant drugs.. Ninety of 221 (41%) cases with a discharge diagnosis of opioid toxicity were treated with naloxone; six patients were excluded because of a lack of toxicity. There was a response to naloxone in 50% of the 84 cases, and recurrence of toxicity in 31% (95% CI 17-45%) of naloxone responders. The most common opioids were codeine, heroin, propoxyphene, and oxycodone/hydrocodone. Recurrence of toxicity was more common with long-acting opioids (p = 0.04), and was not associated with the route of opioid exposure (p = 0.42), or presence of ethanol and other CNS depressants (p > or = 0.87).. Opioid toxicity recurrence after a response to naloxone occurred in approximately 1/3 of adult Emergency Department opioid overdose cases. Recurrence was more common with long-acting opioids and was not associated with the route of opioid exposure. Other clinically useful predictors of toxicity recurrence were not identified.

Topics: Administration, Oral; Adult; Case-Control Studies; Delphi Technique; Emergencies; Female; Humans; Injections, Intravenous; Male; Naloxone; Narcotic Antagonists; Narcotics; Poisoning; Recurrence; Retrospective Studies; Substance-Related Disorders; Suicide, Attempted; Treatment Outcome

A retrospective study was conducted of 40 loperamide poisoning cases recorded at the Centre National d'Informations Toxicologiques Veterinaires. An apparent breed susceptibility of Collie dogs was observed. Neurologic disturbances (ataxia and prostration) were significant clinical findings. Treatment with naloxone resulted in rapid reversal of signs without sequelae.

Topics: Animals; Antidiarrheals; Digestive System Diseases; Dog Diseases; Dogs; Female; Follow-Up Studies; Loperamide; Male; Naloxone; Narcotic Antagonists; Poisoning; Retrospective Studies

For many physicians an antidote is an antidote. According to the International Programme on Chemical Safety definition, an antidote is a therapeutic substance used to counteract the toxic action(s) of a specified xenobiotic. Given this wide definition, the efficacy of an antidote may vary considerably depending on which toxic action(s) being counteracted and the level of counteracting power. An almost 100% efficacy is seen using specific antagonists, such as naloxone in opiate poisoning or flumazenil in benzodiazepine poisoning, e.g. resulting in complete reversal of opiate toxicity unless complications, such as anoxic brain damage, have developed. At the other end of the efficacy scale, we may place chelating agents for heavy metal poisoning and diazepam for organophosphorus insecticide poisoning which are considered only to be an adjuncts to supportive care. When teaching clinical toxicology or recommending the use of antidotes in poisoned patients, the expected efficacy level of the antidote in question should be stressed. This may be particularly important in severe poisoning when the antidote may only be considered as an important adjunct to supportive care, e.g. deferoxamine in acute iron poisoning. Unless this is stressed, the unexperienced physician may rely too much on the antidote and pay insufficient attention to the supportive care. The varying efficacy levels will be discussed based on the presently ongoing International Programme on Chemical Safety/Commission of the European Communities evaluation program on antidotes.

Topics: Antidotes; Atropine; Chelating Agents; Diazepam; Flumazenil; Humans; Naloxone; Poisoning

During the first ten months of 1992 the Oslo Ambulance Department registered 716 incidences of assumed drug-related intoxications. 80% happened in down town Oslo. 19 cases of asystoly were recorded, 13 of the patients recovered after treatment, without sequelae. Five of these patients left the location after emergency help and they refused hospitalization. 432 of the patients were unconscious when the ambulance personal arrived, 472 were treated with naloxone both by the intramuscular and the intravenous route. Most of the persons refused further observation. A team of specially trained out reach workers offers help after acute medical treatment by means of "streetwork". The intervention is directed at addicts who have experienced an overdose.

Topics: Adolescent; Adult; Drug Overdose; Emergencies; Female; Heroin; Heroin Dependence; Humans; Male; Naloxone; Norway; Poisoning; Social Support

Three cases of severe accidental poisoning with "Reasec" in infants and young children are reported. Patients' medical history, the clinical features and ways of antidote administration are described. In severe poisoning in addition to symptomatic intensive care administration of "Narcanti" in continuous infusion is recommended. The necessity of strict observation and ventilation facilities because of the potential respiratory failure is emphasised.

Topics: Accidents, Home; Age Factors; Antidiarrheals; Antidotes; Atropine; Child, Preschool; Diphenoxylate; Drug Combinations; Humans; Infant; Naloxone; Poisoning

The purpose of this study was to isolate significant clinical or demographic findings concerning overdose patients treated during a China White (3-methyl fentanyl) epidemic and compare them with data for all unintentional narcotic overdose patients during a 24-month period.. We reviewed charts from 85,246 patient visits to our emergency department during the 24-month period of January 1987 through December 1988 to study this narcotic epidemic. Data from the Allegheny County Coroner's Office pertaining to unintentional drug overdose deaths that occurred during this same period also were reviewed.. The first outbreak of narcotic overdoses in the eastern United States involving China White occurred in Allegheny County, Pennsylvania, in 1988.. Patients were included if they met the criteria of a suspected unintentional narcotic overdose, but excluded if they were not given naloxone.. Emergency physicians became suspicious of China White use after an unusual increase in narcotic overdoses presenting to the ED coupled with "routine drug of abuse" screens negative for opiates despite dramatic patient responses to naloxone. In most of the cases in which specific testing was done, there were positive indicators of fentanyl derivatives. Investigations found China White present in street drugs and paraphernalia.. A cluster was defined as a time period with a statistically significant increase in overdoses over the expected number for an interval of equal length. Although there were no significant clinical differences in case presentation during the 24-month period, there was a statistically significant 13-fold increase in overdoses during the September through November 1988 cluster (mean, 13 vs 0.95 per month, P less than .001 by Wilcoxon rank-sum test). A dramatic increase in unintentional drug overdose deaths occurred in the county during this cluster. A total of 18 fentanyl-positive unintentional drug overdose deaths, predominantly male (89%) and black (56%), with an age range of 19 to 44 years (mean, 34.9 years), were reported by the county coroner (13 during the cluster). Narcotic overdoses and unintentional drug overdose deaths declined sharply with confiscation of a clandestine China White laboratory.. China White was responsible for a dramatic rise in unintentional drug overdose deaths in Allegheny County in 1988. There were no significant clinical differences between China White overdose survivors and other unintentional narcotic overdose victims. Overdoses responsive to naloxone with inconsistent routine toxicologic screens may be due to a fentanyl analogue.

Topics: Adult; Analgesics; Disease Outbreaks; Drug Overdose; Emergencies; Female; Fentanyl; Humans; Male; Naloxone; Pennsylvania; Poisoning; Retrospective Studies

A child with respiratory distress was found to have been given an antibiotic which was reconstituted with methadone. A delay in standard emergency room management led to a delay in diagnosis and treatment.

Topics: Amoxicillin; Drug Compounding; Female; Humans; Infant; Medication Errors; Methadone; Naloxone; Pharmacies; Poisoning

Clonidine may be a source of serious toxicity when ingested by toddlers. We describe 11 cases of clonidine ingestion by toddlers (mean dose 0.15 mg/kg; range 0.01 to 0.57). The source of the clonidine was a grand-parent in six of 11 cases. Symptoms included altered level of consciousness (n = 11), miosis (n = 5), bradycardia (n = 8), hypotension (n = 5), apnea and respiratory depression (n = 6), hypothermia (n = 5) and hypertension (n = 3). Therapeutic interventions included naloxone (n = 8) and atropine (n = 4), dopamine (n = 1), fluid resuscitation (n = 4), and endotracheal intubation (n = 1). There were no deaths. Symptoms of clonidine ingestion were typically mild if the dose ingested was less than 0.01 mg/kg, while bradycardia and hypotension occurred usually with doses of greater than 0.01 mg/kg. Apnea and respiratory depression were common when the dose exceeded 0.02 mg/kg. More effective measures are needed to prevent these potentially serious intoxications.

Topics: Atropine; Child, Preschool; Clonidine; Consciousness; Critical Care; Dopamine; Dose-Response Relationship, Drug; Female; Fluid Therapy; Humans; Infant; Length of Stay; Male; Naloxone; Poisoning; Resuscitation; Retrospective Studies

Topics: Acetylcysteine; Antidotes; Digoxin; Ethanol; Glucagon; Humans; Immunoglobulin Fab Fragments; Methylene Blue; Naloxone; Poisoning; Pyridoxine

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

Certain basic principles are applicable to most drug overdose emergencies. These include emptying the stomach, administering activated charcoal, supporting vital functions, protecting target organs and using specific antidotes in appropriate cases. There are certain steps to be taken automatically in an unconscious patient with an unknown overdose. Drug screens rarely affect management. Special situations involve overdoses of acetaminophen, salicylates, tricyclic antidepressants, anticholinergics and narcotics.

Topics: Acetaminophen; Acetylcysteine; Antidepressive Agents, Tricyclic; Arrhythmias, Cardiac; Cathartics; Charcoal; Humans; Hypnotics and Sedatives; Ipecac; Naloxone; Narcotics; Parasympatholytics; Poisoning; Salicylates

Topics: Atropine; Cyanides; Edetic Acid; Emergencies; First Aid; Humans; Insecticides; Ipecac; Naloxone; Narcotics; Organophosphorus Compounds; Oxygen; Poisoning

I report the successful treatment of severe infantile opiate poisoning with continuous naloxone infusions. Two infants, one aged 12 months and the other 3 days, were intoxicated with 100 mg normethadone and 5 mg morphine, respectively. They were given constant infusions of 0.04 and 0.16 mg/kg/hr for 2 1/2 and 5 days, respectively. Continuous naloxone infusion should be considered in the management of severe opiate poisoning.

Topics: Humans; Infant; Infant, Newborn; Infusions, Parenteral; Male; Meperidine; Methadone; Naloxone; Poisoning

Intoxicated persons appear frequently in substance abuse centers and in general hospital settings. The severity of their condition ranges from mild impairment to coma or delirium. The prominent features of intoxication with the major classes of abused drugs are described. Staff responses to intoxication are discussed. Guidelines are presented for systematic management of this condition.

Topics: Arrhythmias, Cardiac; Delusions; Diazepam; Hallucinations; Hallucinogens; Humans; Hypnotics and Sedatives; Naloxone; Narcotics; Nonprescription Drugs; Phencyclidine; Poisoning; Seizures; Solvents; Stimulation, Chemical

Topics: Humans; Naloxone; Pentazocine; Poisoning

Topics: Acetaminophen; Acetylcysteine; Adrenergic beta-Antagonists; Adult; Analgesics, Opioid; Child; Cholinesterase Inhibitors; Glucagon; Humans; Immunotherapy; Intestinal Absorption; Methionine; Naloxone; Physostigmine; Poisoning; Poisons; Self Administration

Topics: Humans; Methylprednisolone; Naloxone; Oxygen Inhalation Therapy; Poisoning

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

Management of the acutely poisoned patient should start with decontamination of the skin and irrigation of the eyes, if necessary, and assessment of cardiorespiratory status, neurologic status, and pupils and eye movement. If a definable toxic syndrome is present, the specific "antidote" should be given. If no such syndrome is apparent and the patient is comatose, 50 ml of 50% glucose and 0.4 mg of naloxone (Narcan) intravenously should be tried. General measures, applicable in either situation, include induction of emesis or lavage and administration of charcoal and cathartics.

Topics: Acute Disease; Antidotes; Carbon Monoxide Poisoning; Consciousness; Cyanides; Depression, Chemical; Humans; Naloxone; Nitrates; Nitrites; Organophosphate Poisoning; Oxygen; Parasympatholytics; Poisoning; Pupil; Sodium Nitrite; Thiosulfates

Topics: Antidepressive Agents, Tricyclic; Antidotes; Aspirin; Gastric Lavage; Humans; Hypnotics and Sedatives; Medical History Taking; Naloxone; Physostigmine; Poisoning; Self Medication

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

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Gastric Lavage; Humans; Male; Mannitol; Naloxone; Poisoning; Respiration, Artificial

Poisoning continues to be one of the major causes of mortality and morbidity in young children. The Product Safety Packaging Act needs to be expanded to cover toxic agents and drugs known to be involved in the majority of ingestions. Those agents that are particularly toxic will require more stringent measures than safety packaging. The primary physician is in the position to institute rapid and appropriate therapy for most poisoning. Consideration of poisoning in making a presumptive diagnosis and early institution of general supportive measures are critical. Familiarity with techniques of gastric emptying and with use of activated charcoal and naloxone as antidotes is essential, as is s knowledge of when to refer patients for specialized care. By educating parents about poison proofing the home and about appropriate first aid measures, the primary physician can play an important role in poison prevention.

Topics: Charcoal; Child; Child, Preschool; Emetics; Gastric Lavage; Household Products; Humans; Hydrocarbons; Naloxone; Nonprescription Drugs; Physicians, Family; Physostigmine; Poisoning

The management of the poisoned patient can be difficult and challenging. The task often demands the physician's entire resources in putting together pieces of history and significant physical findings to make a diagnosis. He must then carefully support and stabilize the patient under constant monitoring, while making efforts to prevent further absorption of the toxin, enhance excretion, and treat complications as they arise.

Topics: Adult; Antidotes; Atropine; Child; Emergencies; Emetics; Ethanol; Glucose; Humans; Naloxone; Nitrates; Nitrites; Oxygen; Physostigmine; Poisoning

Topics: Dextropropoxyphene; Humans; Naloxone; Poisoning

Naloxone has been shown to be effective in antagonizing the effects of a number of narcotic and related drugs. Its successful use in managing a patient with an overdose of dextromethorphan extends its application as a specific antidote.

Topics: Dextromethorphan; Female; Humans; Infant; Levorphanol; Naloxone; Narcotic Antagonists; Poisoning

Topics: Antidotes; Cholinesterase Inhibitors; Deferoxamine; Humans; Iron; Methanol; Naloxone; Poisoning; Pralidoxime Compounds

Topics: Humans; Levallorphan; Nalorphine; Naloxone; Narcotic Antagonists; Narcotics; Poisoning

Topics: Adult; Dextropropoxyphene; Humans; Male; Naloxone; Poisoning

Topics: Dextropropoxyphene; Humans; Methadone; Morphine; Naloxone; Poisoning; Suicide, Attempted

Topics: Humans; Infant; Male; Methadone; Naloxone; Poisoning

Topics: Dextropropoxyphene; Humans; Infant; Naloxone; Poisoning; Renal Dialysis

Topics: Adult; Dextropropoxyphene; Female; Humans; Ipecac; Naloxone; Poisoning; Respiratory Insufficiency; Seizures; Vomiting

Topics: Adult; Dextropropoxyphene; Female; Humans; Male; Naloxone; Poisoning; Substance-Related Disorders

Topics: Atropine; Drug Combinations; Humans; Isonipecotic Acids; Naloxone; Poisoning

Topics: Administration, Oral; Boston; Child; Child, Preschool; Drug Packaging; Female; Heroin Dependence; Humans; Infant; Male; Methadone; Naloxone; Poisoning; Respiration

Topics: Administration, Oral; Adult; Analgesics; Barbiturates; Blood Pressure; Drug Tolerance; Female; Humans; Hypnotics and Sedatives; Injections, Intravenous; Male; Middle Aged; Naloxone; Pentazocine; Poisoning; Pulse; Respiration; Substance-Related Disorders; Time Factors; Unconsciousness

Topics: Half-Life; Humans; Naloxone; Narcotic Antagonists; Narcotics; Poisoning

Topics: Atropine; Drug Combinations; Gastrointestinal Agents; Humans; Infant; Ipecac; Isonipecotic Acids; Male; Naloxone; Poisoning; Respiration, Artificial; Seizures; Tachycardia; Vomiting

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

Topics: Anti-Arrhythmia Agents; Antidepressive Agents; Barbiturates; Catecholamines; Diuresis; Gastric Lavage; Humans; Methadone; Muscle Relaxants, Central; Nalorphine; Naloxone; Poisoning; Respiration, Artificial; Vasoconstrictor Agents; Ventricular Fibrillation

Topics: Adult; Dextropropoxyphene; Female; Humans; Injections, Intravenous; Naloxone; Poisoning

Topics: Humans; Naloxone; Opium; Poisoning

Topics: Adolescent; Humans; Injections, Intravenous; Male; Methadone; Naloxone; Poisoning

Topics: Female; Humans; Infant; Medication Errors; Methadone; Naloxone; Poisoning

Topics: Adult; Child, Preschool; Female; Humans; Infant; Male; Methadone; Morphinans; Naloxone; Narcotic Antagonists; Poisoning

Topics: Asphyxia Neonatorum; Female; Fetus; Humans; Infant, Newborn; Injections, Intravenous; Maternal-Fetal Exchange; Naloxone; Narcotics; Poisoning; Pregnancy; Respiratory Insufficiency; Substance-Related Disorders

Topics: Humans; Methadone; Naloxone; Poisoning