Reversal of Opioid-Induced Ventilatory Depression Using Low-Dose Naloxone (0.04 mg): a Case Series.
BACKGROUND
Naloxone is commonly administered in emergency department (ED) to reverse opioid intoxication. Several naloxone dose recommendations exist for acute management of opioid intoxication based on limited published clinical data. A case series of ED patients with opioid-induced ventilatory depression that was reversed using a low-dose naloxone (0.04 mg with titration) is presented.


METHODS
ED patients with opioid-induced ventilatory depression requiring naloxone administration were identified through medical toxicology consultation. Retrospective review of medical records was performed. Collected data included history, and pre- and post-naloxone data, including respiratory rate (RR), pulse oximetry (pulse ox), end-tidal CO2 level (ET-CO2), and Richmond Agitation Sedation Scale (RASS).


RESULTS
Fifteen ED patients with moderate to severe opioid-induced ventilatory depression (median RR, 6 breaths/min) who were managed using low-dose naloxone strategy were identified. Twelve of 15 patients reported ingestion of methadone (range, 30 to 180 mg). The median naloxone dose of 0.08 mg (range, 0.04 to 0.12 mg) reversed opioid-induced ventilatory and CNS depression. Two patients experienced acute opioid withdrawal after receiving 0.08 mg.


CONCLUSIONS
ED patients with moderate to severe opioid-induced ventilatory depression can be reversed using 0.04 mg IV naloxone with appropriate dose titration.
Department of Emergency Medicine, University of Maryland Emergency Medicine Network, University of Maryland School of Medicine, 110 South Paca Street 6th floor, Suite 200, Baltimore, MD, 21201, USA. hongkimmd@gmail.com.
Hong K
HK
Kim
Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center, 462 First Ave. Room A345, New York, NY, 10016, USA.
Lewis S
LS
Nelson
D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage* / Q000009:adverse effects; D062787:Drug Overdose / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage* / Q000009:adverse effects; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D012119:Respiration / Q000187:drug effects*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000931:Antidotes; D009292:Narcotic Antagonists; D009270:Naloxone
Low-dose naloxone; Opioid intoxication reversal; Opioid toxicity