eMedicine Specialties > Emergency Medicine > Toxicology
Toxicity, Opioids: Differential Diagnoses & Workup
Updated: Mar 2, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Pontine hemorrhage
Workup
Laboratory Studies
- Although widely available, drug screens in uncomplicated overdoses rarely alter clinical management. Drug screens are most sensitive when performed on urine. Positive results are observed up to 36-48 hours postexposure, but wide variations are possible depending upon test sensitivity, dose, route, and the patient's metabolism.
- In patients with moderate-to-severe toxicity, performing baseline studies, including a CBC, comprehensive metabolic panel, creatine kinase level, and arterial blood gas determinations, is appropriate.
Imaging Studies
- Obtain chest radiographs if acute lung injury is suspected. Abdominal films may be helpful when evaluating a suspected body stuffer or body packer. Although the body stuffer (ie, a person who quickly swallows drug packages in an effort to hide evidence from police) is more prone to toxicity from hasty preparation, body packers (ie, individuals who carefully seal large amounts of drugs in packages and then swallow them for transport) have much larger amounts of drug liberated should their packages leak. Films suggestive of ingestion are helpful in making a diagnosis, but films negative for drug packages do not rule out potentially life-threatening ingestions.
Other Tests
- An ECG should be obtained on all patients with intentional overdose (possible cardiotoxic co-ingestants) or those with significant toxicity.
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 Differential Diagnoses & Workup: Toxicity, Opioids |
| Treatment & Medication: Toxicity, Opioids |
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Further Reading
Keywords
opioid toxicity, opioid poisoning, opiate addiction, opiate withdrawal, opiate intoxication, opioid analgesics, narcotic toxicity, narcotic poisoning, narcotic overdose, pain relievers, narcotic abuse, narcotic use, opioids, opioid derivatives, opiates, opium, Palaver somniferous, poppy, heroin, codeine, morphine, fentanyl, opioid ingestion, opiate exposures
