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Opioid overdose

Last reviewed: 29 Jun 2025
Last updated: 09 Jul 2025

Summary

Definition

História e exame físico

Principais fatores diagnósticos

  • presence of risk factors
  • miosis
  • bradypnoea
  • altered mental status
  • dramatic response to naloxone
Detalhes completos

Outros fatores diagnósticos

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

Fatores de risco

  • history of prescribed opioids
  • opioid use disorder and dependence
  • recent abstinence in chronic users
  • taking opioids by injection
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • therapeutic trial of naloxone
  • Electrocardiogram (ECG)
Detalhes completos

Investigações a serem consideradas

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

Algoritmo de tratamento

AGUDA

without retained drug packages

with retained drug packages

Colaboradores

Autores

Ruben Thanacoody, MD, FRCP, FRCP(Edin), FEAPCCT

Consultant Physician and Clinical Toxicologist

Director, National Poisons Information Service (Newcastle)

Honorary Clinical Senior Lecturer, Newcastle University

Newcastle-upon-Tyne

UK

Declarações

RT declares that he has no competing interests. RT is an author of a reference cited in this topic.

Agradecimentos

Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this topic.

Declarações

DO declares that he has no competing interests.

Revisores

Joseph Donroe, null

Associate Professor of Medicine

Yale School of Medicine

New Haven

CO

Declarações

JD declares that he has no competing interests.

Anne-Maree Kelley, MD, MClinEd, FACEM

Director

Joseph Epstein Centre for Emergency Medicine Research

Western Health Sunshine Hospital

St Albans

Australia

Declarações

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

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain - United States, 2022. MMWR Recomm Rep. 2022 Nov 4;71(3):1-95.Texto completo  Resumo

Dezfulian C, Orkin AM, Maron BA, et al. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021 Apr 20;143(16):e836-70.Texto completo  Resumo

Resuscitation Council UK. 2021 resuscitation guidelines. 2021 [internet publication].Texto completo

Williams K, Lang ES, Panchal AR, et al. Evidence-based guidelines for EMS administration of naloxone. Prehosp Emerg Care. 2019 Nov-Dec;23(6):749-63.Texto completo  Resumo

Lavonas EJ, Akpunonu PD, Arens AM, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023 Oct 17;148(16):e149-84.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Opioid overdose images
  • Diagnósticos diferenciais

    • Gammahydroxybutyrate (GHB)/gammabutyrolactone (GBL) overdose
    • Clonidine/imidazolines overdose
    • Antipsychotic overdose
    Mais Diagnósticos diferenciais
  • Diretrizes

    • Joint RCEM and NPIS best practice guideline: assessment and management of acute opioid toxicity in adults in the emergency department
    • 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
    Mais Diretrizes
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