Opioid overdose

What it is

Opioid toxicity is a clinical diagnosis. Opioids are grouped as naturally occurring compounds, termed opiates, chemical modifications of natural compounds, which are semisynthetic, and completely artificial compounds, which are synthetic. They are among the drugs most frequently involved in reported toxic drug exposures, and the order is marked on the table of major pharmaceutical opioids: tramadol first, oxycodone second, methadone third and morphine fourth. The immediate problem in overdose is respiratory depression, and reversing that is the goal of treatment.

How it presents

The bedside triad is a depressed conscious level, a slow respiratory rate and pinpoint pupils: check the GCS and the pupils, and if they are pinpoint with a reduced respiratory rate in a comatose patient, that is when to try naloxone.

One management route treats a rate under 12 breaths/min, in a patient who is not asleep, as opioid overdose.

The blood gas shows the effect on breathing rather than the drug: a venous gas with a pH of 7, a PaCO2 of 82, a PaO2 of 20 and a lactate of 7 is the picture of a patient who has stopped breathing adequately.