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Potentially life-threatening emergency
Opioid toxicity
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Potentially life-threatening emergency

Opioid toxicity

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Contributors: Jamie Adams MD
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Synopsis

Toxic use of opioids. Originally extracted from the poppy plant / derived from opium, opioids now also include synthetic and semisynthetic drugs. Examples are morphine and codeine (natural opiates); heroin, oxycodone, oxymorphone, hydrocodone, hydromorphone, and buprenorphine (semi-synthetic opioids); and meperidine (Demerol), fentanyl and fentanyl analogs such as carfentanil and remifentanil, and methadone (synthetic opioids). Opium can be contaminated with lead.

There are three major types of opioid receptors in the body, and toxicity effects are dependent on the function of each group. There are different preparations of opioids, from synthetic methadone with a 27-hour half-life to shorter-acting, natural instant-release morphine with a half-life of 2 hours. Thus peak serum concentration will be directly linked with the type of ingestion, making history taking critical.

Common clinical features of acute toxicity include altered mental status, miotic pupils, decreased bowel sounds, bradycardia, hypoglycemia, hypotension, and respiratory depression; in severe intoxication, respiratory and cardiac arrest can occur. Toxicity of other medications including acetaminophen may also occur with coingestions.

Resources for opioid prescribing guidelines, as well as nonopioid alternatives, can be found here.

Related topics: Opioid Use Disorder, Opioid Withdrawal Syndrome

Codes

ICD10CM:
T40.2X1A – Poisoning by other opioids, accidental (unintentional), initial encounter

SNOMEDCT:
241749009 – Poisoning by opiate analgesic drug

Differential Diagnosis & Pitfalls

Best Tests

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 11/13/2018
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Potentially life-threatening emergency
Opioid toxicity
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Opioid toxicity (Acute Toxicity) : Altered mental state, Orthostatic hypotension, Decreased bowel sounds, Drowsiness, Miosis, RR decreased, Depression
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