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Opioid toxicity in renal impairment — SCE Acute Medicine MCQ

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HardCancer and Palliative Care and HaematologyOpioid toxicity in renal impairmentSCE Acute Medicine

A 57-year-old woman with metastatic ovarian cancer is receiving modified-release morphine. She is admitted with pneumonia and AKI, then becomes increasingly drowsy with pinpoint pupils and RR 7. Oxygen saturation improves with oxygen but ventilation remains poor. What is the most appropriate next step in management?

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Correct answer: E — Give titrated naloxone while preserving analgesia and review opioid dosing

Renal impairment can precipitate opioid toxicity with reduced consciousness, miosis and respiratory depression, requiring carefully titrated naloxone. Large boluses can cause severe pain, withdrawal and sympathetic surge. Oxygen alone does not correct hypoventilation. The palliative care nuance is to reverse dangerous respiratory depression while maintaining proportionate analgesia.

Reference: BNF, NICE CKS palliative care pain, local palliative care guidance