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Opioid overdose requiring naloxone infusion — SCE Acute Medicine MCQ

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ModerateClinical pharmacology and poisoningOpioid overdose requiring naloxone infusionSCE Acute Medicine

A 42-year-old man is brought in after heroin use with respiratory rate 6/min, pinpoint pupils and oxygen saturation 82% on air. He responds to initial naloxone but becomes drowsy again after 20 minutes. Friends report he may also have taken a long-acting opioid tablet. What is the most appropriate next step in management?

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Correct answer: E — Start a naloxone infusion titrated to adequate ventilation

Recurrent respiratory depression after naloxone suggests opioid effect outlasting the antagonist, particularly with long-acting opioids, so infusion and observation are needed. The endpoint is adequate ventilation, not full arousal. Flumazenil is risky in mixed overdose and does not treat opioid respiratory depression.

Reference: TOXBASE opioid poisoning; BNF naloxone