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Paediatric opioid poisoning — RCPSC EM MCQ

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HardToxicologyPaediatric opioid poisoningRCPSC EM

A 3-year-old is brought after being found with grandparents' tablets. He is sleepy, respiratory rate is 8/min and pupils are pinpoint. After IV naloxone he wakes briefly, then becomes bradypnoeic again after 25 minutes. What is the most appropriate initial management?

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Correct answer: A — Start a naloxone infusion titrated to adequate ventilation and monitor for recurrent toxicity

Recurrent respiratory depression after naloxone suggests ongoing opioid toxicity, particularly with long-acting opioids. A titrated infusion and monitored observation are required.

Reference: Canadian poison centre guidance; PALS