Adult Medical Emergency Handbook - Scottish Intensive Care Society

i
The plasma half-life of naloxone is shorter than that of
most opioids, so repeated doses are often required. This
is especially true of long-acting opiates (e.g. MST or
methadone), where a naloxone infusion might be needed.
• Naloxone infusion is usually started at around 60% of the initial
dose per hour. A solution containing 5 mg (12.5 ampoules)
reconstituted in 25 mls dextrose gives a 200 micrograms/ml
solution for IV infusion via a syringe driver.
• Measure U&Es and CK. N.B. patients who have reduced
conscious level are at high risk of rhabdomyolysis, pressure
injuries and compartment syndromes.
RECREATIONAL DRUGS
Features
• Stimulants such as MDMA (ecstasy), amphetamines, cocaine,
lysergic acid diethylamide (LSD) may cause severe agitation,
tachycardia, sweating, pyrexia, dilated pupils, hypertension,
arrhythmia and seizures. Severe cases result in coma,
rhabdomyolysis, renal failure, subarchnoid haemorrhage,
myocardial infarction, refractory seizures and death.
Specific features
• Cocaine also causes coronary artery spasm, myocardial
ischaemia and infarction and aortic dissection.
• Ecstasy may cause severe hyponatraemia.
• Gamma hydroxybutyrate (GHB) may cause bradycardia,
hypotension, reduced conscious level and coma and may be
associated with severe withdrawal symptoms.
Management
• Measure U&Es, LFTs and CK.
• Perform ECG and monitor cardiac rhythm.
• Control agitation and seizures with diazepam. Large doses and
repeated administration may be required.
• Hypertension usually settles after administration of diazepam.
If hypertension persists despite diazepam, then consider
intravenous nitrates (e.g. glyceryl trinitrate 1-2 mg/hour) and
gradually increase the dose until blood pressure is controlled.
• Treat cocaine induced chest pain and ECG changes with aspirin,
diazapem and nitrates.
• Tachycardia usually responds well to adequate sedation and
control of agitation, and specific therapy is not normally needed.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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