Narcan or Narcan’t?

​Part 2 in a Four-part Series​A 57-year-old man presented with acute onset altered mental status. His family said he had been behaving normally. Prior to dinner, however, he became difficult to arouse, and was speaking gibberish. He was somnolent but arousable to physical stimuli on arrival in the ED.He answered questions inappropriately and would then go back to sleep. His past medical history was consistent with hypertension, hypercholesterolemia, and spinal fusion a month ago. His medications included lisinopril, atorvastatin, and hydrocodone. His vital signs were a blood pressure of 110/65 mm Hg, heart rate of 90 bpm, temperature of 98.5°F, respiratory rate of 6 bpm, and pulse oxygen of 95% on room air. He had no focal neurologic deficits and pupils at 3-2 mm bilaterally.How Naloxone Works and the Correct DosageNaloxone works as a competitive mu opioid-receptor antagonist. The dosage is empirical and depends on the amount of opioid taken, the type of opioid, and how dependent the patient is on opioids.All three factors should be considered before administering naloxone. The initial dose should be small (0.04 mg), followed by escalating doses (0.5 mg, 1 mg, 2 mg, 4 mg, 10 mg, 15 mg) every two to three minutes until there is a response. (N Engl J Med 2012;367[2]:146.) More potent opioids, such as synthetic fentanyl analogs and buprenorphine, may require higher levels of naloxone. Patients who are opioid-dependent like the patient in this case will have precipitated...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs