title: Successful management of drug-induced hypercapnic acidosis with naloxone and noninvasive positive pressure ventilation.
abstract: A 74-year-old man was referred to our hospital due to deteriorating level of consciousness and desaturation. His Glasgow Coma Scale was 6, and his pupils were constricted but responded to light. Chest radiograph was negative for significant findings. Arterial blood gas evaluation on supplemental oxygen revealed severe acute on chronic respiratory acidosis: pH 7.15; PCO2, 133 mm Hg; PO2,64 mm Hg; and HCO3, 31 mmol/L. He regained full consciousness (Glasgow Coma Scale, 15) after receiving a 0.4 mg dose of naloxone, but because of persistent severe respiratory acidosis (pH 7.21; PCO2, 105 mm Hg), he was immediately commenced on noninvasive positive pressure ventilation (NIV) displaying a remarkable improvement in arterial blood gas values within the next few hours. However, in the days that followed, he remained dependent on NIV, and he was finally discharged on a home mechanical ventilation prescription. In cases of drug-induced respiratory depression, NIV should be regarded as an acceptable treatment, as it can provide ventilatory support without the increased risks associated with invasive mechanical ventilation.
authors.affiliation: Department of Pulmonary Medicine, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Thessaloniki, Greece. Electronic address: m.agrafiotis@gmail.com.
authors.forename: Michalis
authors.initials: M
authors.lastname: Agrafiotis
authors.affiliation: Department of Pulmonary Medicine, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Thessaloniki, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Tryfon
authors.affiliation: Department of Pulmonary Medicine, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Thessaloniki, Greece.
authors.forename: Demetra
authors.initials: D
authors.lastname: Siopi
authors.affiliation: Department of Pulmonary Medicine, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Thessaloniki, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Chassapidou
authors.affiliation: Department of Pulmonary Medicine, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Thessaloniki, Greece.
authors.forename: Artemis
authors.initials: A
authors.lastname: Galanou
authors.affiliation: Department of Pulmonary Medicine, "Georgios Papanikolaou" General Hospital of Thessaloniki, Exohi, Thessaloniki, Greece.
authors.forename: Venetia
authors.initials: V
authors.lastname: Tsara
mesh_terms: D000138:Acidosis / Q000139:chemically induced / Q000188:drug therapy / Q000628:therapy*; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D003131:Combined Modality Therapy; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D006935:Hypercapnia / Q000139:chemically induced / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D011175:Positive-Pressure Respiration; D014147:Tramadol / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D014147:Tramadol; D005283:Fentanyl