The Case Files: Serious and Unusual Reaction to Naloxone Administration

By Anthony Congeni, Alex Fox, MD, & Andrew King, MD Naloxone is given routinely in the hospital and prehospital setting without much concern for significant morbidity. Many providers are unaware of its potential complications, including pulmonary edema, and may be caught off guard when respiratory distress occurs in an awake patient who was previously rescued with naloxone. The use of naloxone is now common in anesthesiology and emergency medicine for patients with concern for opiate toxicity. Its use, however, is not without occasional morbidity, particularly cardiopulmonary complications including pulmonary edema. (J Toxicol Clin Toxicol 1996;34[4]:409; Expert Opin Drug Saf 2007;6[2]:125; Oral Surg Oral Med Oral Pathol 1981;52[6]:602; Anesthesiology1977;47[4]:376.) Among reported cases, these episodes have occurred more frequently after postoperative opiate intoxications, though non-postoperative cases have also been described. (Anaesthesist 2012;61[2]:129.) The pathogenesis of naloxone-associated pulmonary edema remains controversial, and the emergency medicine literature on this phenomenon, including its potential emergence in the pre-hospital setting, is limited. Our patient was a 37-year-old previously healthy male inmate. He was “roughhousing” when he struck his head and went to sleep. Sometime later, the patient was witnessed sliding out of bed, unresponsive. Bystanders reported that the patient had taken heroin prior to the episode, and the facilit...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research