Narcotic Overdose

1. See Also
   1. Opioid
2. Indications: Narcotic Overdose management
   1. Respiratory Depression (Hypoxia, apnea)
   2. Severe Sedation (e.g. comatose)
3. Symptoms
   1. Constipation
   2. Nausea
   3. Vomiting
   4. Flushing
   5. Pruritus
4. Symptoms and Signs
   1. Altered Level of Consciousness (CNS depression or Sedation)
      1. Coma
      2. Lethargy
      3. Stupor
   2. Hypotension
   3. Miosis (except Demerol which causes Mydriasis)
   4. Pulmonary edema
   5. Respiratory depression
   6. Seizures
5. Precautions
   1. Close monitoring must be continued after antidote
      1. Narcotic half-life might exceed that of Naloxone
   2. Consider Very Low Dose Naloxone Protocol
      1. Indicated for Cancer Pain or Chronic Pain (prevents severe rebound pain)
6. Management: General
   1. Naloxone at doses below
   2. Consider for long acting Opioids: Nalmefene (Revex)
7. Management: Naloxone (Narcan)
   1. Adults
      1. Initial
         1. No respiratory depression: 0.1 to 0.4 mg IV or IM
         2. Respiratory depression: 1 to 2 mg IV or IM
      2. Next, if no response or incomplete response
         1. Give 2 mg IV or IM every 3-5 minutes to a total of 10-20 mg
   2. Children
      1. Initial
         1. No respiratory depression: 0.1 mg/kg to 0.4 mg IV or IM
         2. Respiratory depression: 1 to 2 mg IV or IM
      2. Next, if no response or incomplete response
         1. Give 2 mg IV or IM every 3-5 minutes to a total of 10-20 mg