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Opioid overdose with recurrent respiratory depression — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseOpioid overdose with recurrent respiratory depressionSCE Acute Medicine

A 41-year-old man is found drowsy with pinpoint pupils after using illicit opioids. Respiratory rate is 6/min and oxygen saturation is 82% on air. He responds to titrated intravenous naloxone but becomes hypoventilated again 40 minutes later. There is suspicion of methadone exposure. What is the most appropriate next step in management?

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Correct answer: C — Start a naloxone infusion titrated to respiratory effort

Recurrent respiratory depression after naloxone, especially with long-acting opioids, requires ongoing titration such as infusion and monitoring. Discharge after transient response is unsafe because naloxone may wear off before the opioid. Flumazenil can precipitate seizures and is not the opioid antidote. The pearl is to titrate naloxone to ventilation rather than to full alertness.

Reference: BNF naloxone; TOXBASE; NICE CKS poisoning