The Agony of Withdrawal
Part 3 in a Four-Part SeriesA 26-year-old man presented with fatigue. He complained of body aches, diarrhea, and nausea. His history was significant for chronic back pain, for which he had been prescribed oxycodone that he has taken daily for three years. He reported that he had stopped taking it two days before his visit.He denied other medication or drug use. He was alert but restless and diaphoretic. His ECG showed sinus tachycardia. His labs included a WBC of 12, Hgb of 12, glucose of 89 mg/dL, creatinine of 1.0 mg/dL, sodium of 140 mEq/L, potassium of 3.8 mEq/L, and CK of 140 U/L. He was experiencing opioid withdrawal.The symptoms of opioid withdrawal include:-Muscle aches-Restlessness-Anxiety-Lacrimation-Rhinorrhea-Diaphoresis-Insomnia-Yawning-Diarrhea-Piloerection-Abdominal cramping-Nausea and vomitingThe Clinical Opiate Withdrawal Scale can be used to help quantify the severity of opiate withdrawal using some of the symptoms experienced in withdrawal. (http://bit.ly/MDCalcCOWS.)Non-Opioid Treatments for Withdrawal SymptomsSymptomsTreatmentMyalgias, arthralgiasNSAIDs/acetaminophen; alsomuscle relaxers such as baclofen,tizanidine, and methocarbamol(use with caution)Autonomic effectsClonidineDiarrheaOctreotide/LomotilNausea, vomitingOndansetron/metoclopramideThese medications may help withdrawal symptoms in the immediate future, but it is important to realize that these patients will have physical withdrawal symptoms for up ...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
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