In the Nalox“ZONE”

A 27-year-old woman with no past medical history presented to the ED by EMS after being found unresponsive at home by her partner. EMS reported that she was unresponsive with a GCS of 3, pinpoint pupils, and sonorous breath sounds. Naloxone 0.4 mg IV was administered, and the patient became responsive. The patient was delirious, agitated, and tachycardic upon arrival to the ED. She was administered lorazepam 2 mg IV without improvement. Her agitation and delirium were so severe that she was intubated, paralyzed with rocuronium, and started on a midazolam infusion.   What is the appropriate dose of IV naloxone? No consensus exists on the appropriate starting dose of naloxone, but many toxicologists recommend a starting dose of naloxone 0.04 mg IV in opioid-dependent patients, quickly titrating up every two minutes to a maximum of 10 mg. If no effects are seen after 10 mg, the patient’s respiratory or CNS depression are unlikely to be a result of opioid toxicity. Special considerations should be taken in certain populations, including opiate-naive patients and children where larger doses of Narcan can be used initially to reverse the respiratory depression.   Adverse effects have been reported at doses as low as 0.4 mg IV, which support a starting dose of 0.04 mg. It is important to remember that most adverse effects are from acute opioid withdrawal rather than to the naloxone itself.   To administer naloxone 0.04 mg IV, dilute a naloxone preparation of 0.4 mg/1ml a...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs