Occurs when a person is administered opiates in larger quantities than can be physically tolerated

Pathophysiology

Commonly triggered by:

• Overmedication
• Renal failure
• Frailty and intercurrent illness

Clinical features

Earlier signs

• Hallucinations
• Myoclonic jerks/twitching
• Vivid dreams

Signs of opioid overdose

• Small, constricted pinpoint pupils
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Pale, blue, or cold skin
• Blue nails or lips

Management

• Naloxone - titrate gradually as rapid reversal can be very distressing
  • Aim to restore respiratory stability but not cause rebound pain