Opioids

Opioids is a topic covered in the Washington Manual of Medical Therapeutics.

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Diagnosis

Clinical Presentation

Symptoms of opioid overdose are respiratory depression, a depressed level of consciousness, and miosis. However, the pupils may be dilated with acidosis or hypoxia or following an overdose with meperidine, propoxyphene, dextromethorphan, or a stimulant.

Diagnostic Testing

Laboratories

Drug concentrations and other standard laboratory tests are of little use. Urine drug screens are associated with multiple false positives and negatives. This is especially true considering the current epidemic involving synthetic opioids and fentanyl derivatives. Opioid intoxication is a clinical diagnosis.

Imaging

  • A CXR should be obtained if pulmonary symptoms are present or there is concern for aspiration.
  • CT scans are not reliable in determining packet burden in body packers.

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Diagnosis

Clinical Presentation

Symptoms of opioid overdose are respiratory depression, a depressed level of consciousness, and miosis. However, the pupils may be dilated with acidosis or hypoxia or following an overdose with meperidine, propoxyphene, dextromethorphan, or a stimulant.

Diagnostic Testing

Laboratories

Drug concentrations and other standard laboratory tests are of little use. Urine drug screens are associated with multiple false positives and negatives. This is especially true considering the current epidemic involving synthetic opioids and fentanyl derivatives. Opioid intoxication is a clinical diagnosis.

Imaging

  • A CXR should be obtained if pulmonary symptoms are present or there is concern for aspiration.
  • CT scans are not reliable in determining packet burden in body packers.

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