A young man with known history of heroine addiction is brought in the emergency in unconscious state by his friends. On examination his pupil are pin point. What will be the treatment of choice?
Ans. b. IV naloxone (Ref: Harrison 19/e 468e-3, 468e-3t, 473e-3, 473e-13t 18/e p3554 Reddy's Essential of Forensic Medicine and Toxicology 27/e p457-460, 552: Reddy 33/e p586)IV naloxone is the treatment of choice in Opioid overdose.So, in this patient with suspected Opioid (heroine) overdose, treatment of choice is IV naloxone.Treatment of Opioid OverdoseTreatment of opioid overdose requires:NaloxoneQ: 0.4-2.0 mg IV or IM with expected response within 1-2 minutesSupport of vital functions:Oxygen and positive pressure breathingIV fluidsPresser agents for hypotensionCardiac monitoring to detect QT prolongationOpioidWithdrawal SyndromeDOC in withdrawal syndrome* YawningQ, Insomnia, Dysphoric mood* Water loss from different orificesQ (LacrimationQ, sweatingQ, diarrheaQ, vomiting, rhinorrheaQ)* Increased vitalsQ (BP, Pulse, RR, Temperature)Q* Pupilary dilation, piloerectionQ* Methadone (1st choice)* Clonidine (2nd choice) Pupillary reactionMiosis (Constricted pupil)Mydriasis (Dilated pupil)* Carbolic acidQ* Chloral hydrateQ* Morphine (opium)Q* Organophosphorus poisoningQ* BarbituratesQ* Pontine hemorrhageQ* Muscarine* Nicotine* Viper venomQ* DhaturaQ* AlcoholQ* AconiteQ* Nux vomicaQ* Cyanide, cocaine, COQ* Chloroform* Ether* Pethidine
Oral naltrexone
IV naloxone
Oral diazepam
Oral buprenorphine
Forensic Toxicology - Concepts, Statutes, Evidence, and Techniques