Buprenorphine ingestion in a 23-month-old boy
| Autor: | William H. Richardson, Greg S. Swartzentruber, Elizabeth H. Mack |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Respiratory rate Narcotic Antagonists Biological Availability Bradypnea Disorders of Excessive Somnolence Pediatrics Naloxone medicine Ingestion Humans business.industry Infant General Medicine Surgery Buprenorphine Analgesics Opioid Treatment Outcome Opioid Accidents Home Pill Anesthesia Pediatrics Perinatology and Child Health Vomiting Neurotoxicity Syndromes medicine.symptom business Respiratory Insufficiency medicine.drug |
| Zdroj: | Hospital pediatrics. 5(3) |
| ISSN: | 2154-1663 |
| Popis: | Case: A previously healthy 23-month-old 12.6-kg boy presented to an outside community emergency department with vomiting and respiratory depression after a single episode of red-orange emesis that looked and smelled like his mother’s buprenorphine/naloxone tablets (8 mg/2 mg formulation). She reported slowed respirations, small pupils, and somnolence, but she denied witnessing any ingestion; therefore, the amount ingested and the time of ingestion remained unknown. At presentation to the emergency department, the patient’s respiratory rate was 14 per minute, with an oxygen saturation of 93% on room air; pupils were miotic, and the patient was described as lethargic. He was treated with 0.4 mg (0.03 mg/kg) of intravenous naloxone initially, without documented improvement in arousal or respiratory status. A second dose of naloxone 0.4 mg was administered intravenously immediately after the first dose. This second dose of naloxone resulted in arousal with crying and a respiratory rate of 18 per minute. At this time he was given 1 g/kg activated charcoal with sorbitol orally. A third dose of naloxone 0.4 mg was administered 20 minutes after the second dose, and at that time a naloxone infusion was initiated at 0.06 mg/hr. Approximately 15 minutes after initiation of the infusion he experienced recurrence of somnolence and bradypnea, and the naloxone infusion was increased to 0.2 mg/hr (0.015 mg/kg) with improvement. The patient was then transferred to the PICU. Question: Why can it be more concerning to find buprenorphine pill fragments in the mouth than to have a known ingestion in which pills are swallowed? Discussion: Buprenorphine is a semisynthetic opioid available in commercial form in the United States as a single tablet, a combination pill with naloxone, an injectable solution, a sublingual film with naloxone, and a topical patch. Suboxone (buprenorphine/naloxone) is a lemon-lime flavored, orange-colored tablet. Buprenorphine is a partial μ … |
| Databáze: | OpenAIRE |
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