ISSN: 1305-3876
Dil: Türkçe
Hakkında: Özel sayılar şeklinde yayınlanır.
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Diagnosis And Treatment Of Acute Opioid Intoxications
Dr. Ayşin ALAGÖL,a Dr. Beyhan KARAMANLIOĞLUa
aAnesteziyoloji ve Reanimasyon AD, Trakya Üniversitesi Tıp Fakültesi, EDİRNE
Acute intoxication with opioid analgesics usually occurs as suicids in elderly and as accidents in children as a result of overdosing. Main symptom and signs of acute intoxication are decreased conscious, respiratory depression and myosis. Non-cardiogenic pulmonary edema, cardiac depression, hypoxia and syanosis are frequently determined. Blood sample for toxicologic studies and chest X-ray are indicated in each case. Obtaining and maintainning of airway and-especially in patients with deep coma or, inadequate respiratory effort or pulmonary edema-endotracheal intubation and mechanical ventilation are indicated. A venous line and haemodynamic stability have to be obtained. Fifty mL dextrose 50% and 100mg thiamin intravenously may be necessary. Management of convulsions and hypothermia are indicated. Preventing absorption of orally intaked drugs can be obtained by gastric emptying and intestinal lavage. Gastric lavage is effective when the drug was taken before less than 1 hour, when it decreases gastric emptying time (anticholinergic effect), if it ligands to active charcoal weakly, or in case of life threating intoxication. After gastric emptying or if it is not possible, active charcoal can be administered orally. Intestinal lavage is used in heroin carriers. In combined intoxications with salycylate and opioids alcaline diuresis is indicated or, hepatic or renal insufiency extracorporeal elimination can be performed. Naloxone, pure antagonist, is the antidote which blokes μ, δ, κ opioid receptors. It antagonizes respiratory depression, analgesia, hypotension, hyperglycemia, increased vasopressin depletion, myosis, gastrointestinal and biliar effects. The initial dose is 0.4-0.8mg. As duration of opioid effects are longer than that of naloxone, repeated dese sor infusion is needed. If acetaminophen is received with opioid, N-acetyl cystein may be indicated.Keywords: analgesics, opioid, intoxicationTurkiye Klinikleri J Surg Med Sci 2006, 2(46):95-100
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