Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • history of opioid abuse and dependence
  • miosis
  • bradypnea
  • altered mental status
  • dramatic response to naloxone

Other diagnostic factors

  • fresh needle marks
  • drug paraphernalia nearby
  • decreased GI motility
  • old track marks on arms and legs
  • pulmonary rales
  • frothy pink sputum
  • seizures
  • dysrhythmias

Risk factors

  • opioid abuse and dependence
  • recent abstinence in chronic users
  • chronic pain

Diagnostic investigations

1st investigations to order

  • therapeutic trial of naloxone
  • ECG
Full details

Investigations to consider

  • chest x-ray
  • abdominal x-ray
  • abdominal CT scan
  • opioid urine screen
  • gas chromatography/ mass spectrometry
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Physician and Clinical Toxicologist

National Poisons Information Service (Newcastle)

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests.

Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this monograph. DO declares that he has no competing interests.

Peer reviewers VIEW ALL

Staff

Gynecologic Oncologist

Northwest Cancer Specialists

Rose Quarter Cancer Center

Portland

OR

Disclosures

WW declares that he has no competing interests.

Director

Joseph Epstein Centre for Emergency Medicine Research

Western Health Sunshine Hospital

St Albans

Australia

Disclosures

AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.

Assistant Professor

Johns Hopkins University

Baltimore

MD

Disclosures

AS declares that he has no competing interests.

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